WRI40 
F794e 
1876 


r 

0  ^ 
Oi 

0: 

4 

3 

1 

4 
9 
5 

1 

1—^^-^  z 

TELEPHONE.  UPLAND  26 


^(ro 


DR.  C.  H.  WIMPRESS 

OSTEOPATHIC  PHYSICIAN 


N.   W.  CORNEK  KUCLIO  AVCNUK  AND 
VIRNON  ORIVK 

AT  JUNCTION  OF  STREET   RAILWAY  UPLAND,    CAL. 


Digitized  by  tlie  Internet  Arcliive 

in  2007  witli  funding  from 

IVIicrosoft  Corporation 


littp://www.arcliive.org/details/epitomeofskindisOOfoxtiala 


lEPITOME 


SKIN    DIS^EiSESi^m 


WITH   FORMULA. 


f  -  r.  r  r, 


FOR  STUDENTS  AND  PRACTITIONERS. 


i 


BY 


TILBURY  FOX,  M.D.,  F.R.C.P., 

PHYSICIAN    TO    THE    DEPAUTMENT    FOR    SKIN    DISEASES    IN  UNIVERKITT 

COLLEGE  HOSPITAL, 

AUTHOR  OF  VARIOUS  WORKS  ON  SKIN  DISEASES,  ETC. 

AND 

T.  C.  FOX,  B.A.  (Cantab.),  M.R.C.S. 


PHILADELPHIA: 

HENRY     C.     LEA 

1816. 


0   ^  ^W;^l^'l.i 


PHtLADBLPBIA: 
rOLLINB,      PRIKTER, 

70.^  Jayne  Street. 


c 


PREFACE, 


This  little  work  epitomizes  in  a  short  compass 
the  clinical  features  and  the  essential  points  in  the 
treatment  of  diseases  of  the  skin. 

The  book  can  be  easily  carried  in  the  pocket — 
an  advantage  to  the  student ;  and  it  is  believed 
that  it  will  be  of  much  service  to  him  in  the  Hos- 
pital wards  and  out-patient  room,  in  his  early 
study  of  dermatology,  no  less  than  in  his  final 
preparations  for  the  ordinary  pass  examinations. 

The  work  is  also  intended  for  read}-  reference 
by  the  practitioner  in  daily  practice.  It  is  adapted 
for  this  purpose  on  account  of  the  particular  refer- 
ences made  in  the  text,  in  the  sections  on  treatment, 
to  particular  formulae  contained  in  the  third  part 


iV  PREFACE. 

of  the  book  as  suitable  for  use  against  conditions 
of  disease  si>eeially  defined  in  the  text. 

The  work,  however,  in  no  way  supersedes  larger 
works  on  the  subject  of  skin  diseases. 

TILBURY  FOX, 
T.  C.  FOX. 

U  Hari.ey  Strekt,  Cavendish  Square, 
Oct.  l8t,  1876. 


COI^TENTS. 


PART   I. 

Generai,  Observations  on  Skin  Diseases 


PAGE 
.  1 


SECTION   I. 

Indications  for  the  Study  op  Skin  Diseases  : — 

1.  As  to  the  General  Character  of  Skin  Eruptions  .  1 

2.  As  to  the  Mode  of  Examining  Skin  Diseases       .  .       2 

3.  As  regards  Complications    .         .         .         .         .  .       5 

4.  As  regards  Modifications  of  Eruptions         .   "      .  .5 


SECTION    II. 


Elementary  Lesions 


SECTION    III. 

Classification  or  Diagnostic  Chart  of  Skin  Diseases  : — 

1.  Eruptions  occurring  in   Connection  with   the   Acute 

Specific  or  Zymotic  Diseases     .....  12 

2.  Eruptions 12 

3.  Local  Inflammations  .......  13 

4.  Hypertrophic  and  Atrophic  Diseases  .         .         .         .13 

5.  New  Formations          .......  14 

6.  Haemorrhages      ........  14 

7.  Neuro.ses      .........  14 

8.  Pigmentary  Alterations       ......  14 

9.  Parasitic  Diseases         .......  14 

10.  Diseases  of  the  Glands  and  Appendages     .         .         .15 


SECTION    IV. 
The  Causes  op  Skin  Diseases 


16 


VI 


CONTENTS. 
SECTION    V. 


Diagnosis      

SECTION    VI. 
Trbatmbnt  (Gbnssal  Principles) 


PAUB 

.     23 


25 


PART    II. 

Thk  Description  a.vd  Treatment  of  Skin  Diseases  31 

31 

33 

34 


Aone 

Alopecia  or  Baldness        .... 

Anthrax  or  Carbuncle     .... 

Area,  ue  Alopecia. 

Atrophia  Cutis         ..... 

Bakers'  Itch  ..... 

Baldness,  see  Alopecia. 

Barbadoes  Leg,  see  Bucnemia. 

Boils,  see  Furunouli. 

Bricklayers'  Itch     ..... 

Bucnemia  Tropica  ..... 

Bag-eruption  ...... 

Cancer,  see  Epithelioma  and  Rodent  Ulcer. 

Carbuncle,  see  Anthrax. 

Chloasma,  see  Tinea  versicolor. 

Comedones 

Condylomata  . 

Contagious  Impetigo 

Dysidrosis 

Ecthyma 

Eczema    .... 

Elephantiasis  . 

Epithelioma,  or  Epithelial  Cancer 
Erythema,  or  simple  redness  (bypertemia) 
Favus,  see  Tinea  favosa. 

Fibroma 

Fish  Skin  Disease,  see  Ichthyosis. 
Follicular  Hypersemia     .... 
Fungi,  see  Tinea. 
Furunoulus      ...... 

Grocers'  Itch 

Outta  rosacea,  see  Acne  rosacea. 
Herpes     .....".. 

Hydroa    ....... 

Hydroadenitis  ..... 


35 
36 


36 
36 
37 


38 
38 
38 
40 
41 
42 
46 
47 
47 

49 

50 

50 
51 

52 
53 
54 


CONTENTS. 


vu 


Hyperidrosis    .       •  . 

Ichthyosis 

Impetigo 

Intertrigo,  see  Erythema. 

Itch,  see  Scabies. 

Keloid     .  .         . 

Kerion,  see  Tinea  kerion. 

Lepra       .... 

Lencoderma     . 

Lichen    .... 

Lichen  urticatus,  see  Urticaria 

Lupus      .... 

Maculae    .... 

Medicinal  rashes 

Miliaria  .... 

Molluscum  contagiosum 

Morphoea 

Nails        .... 

Pedieuli,  see  Phthiriasis. 

Pemphigus 

Phthiriasis 

Pityriasis 

Porrigo    . 

Prickly  Heat,  or  Lichen  Tropi 

Prurigo 

Pruritus,  or  Itching 

Psoriasis 

Purpura  .... 

Ringworm,  see  Tinea. 

Rodent  ulcer  . 

Roseola  .... 

Rupia      .... 

Scabies  or  Itch 

Scabies  in  Private  Practice 

Scleroderma    . 

Scrofuloderma 

Seborrhoea 

Strophulus  or  Red  Gum 

Sudamina 

Sycosis    .         . 

Syphilis  of  the  Skin 

Tinea       .         . 

Urticaria,  or  Nettlerash 

Vitiligoidea     . 

Xanthelasma   . 

Xanthelasmoidea 

Xeroderma,  see  Ichthyosis. 

Zoster,  see  Herpes. 


PAOR 

.  64 
.  55 
,     66 


66 


Vlll 


CONTENTS. 


PART    III, 


PAOK 

CUTANBOUS  PhARMACOP<EIA 100 

Bntbs 

100 

Fumigation    . 

101 

Caustics 

101 

Astringents    . 

102 

Sedatives 

103 

Absorbent  Powders 

107 

Stimulants  and  Absorbents 

107 

Pinsters 

111 

Mixtures 

.     Ill 

Pills       .... 

114 

Remedies  for  Scabies  and  Phthiriasis 

115 

116 

Diet  in  Skin  Diseases 

118 

EPITOME  OF  SKIi\  DISEASES. 


PAET    I. 

GEI!^ERAL  OBSERVATIONS  ON 
SKIN  DISEASES. 


SECTION    I. 

INDICATIONS  FOR  THE  STUDY  OF    SKIN  DISEASES. 

In  the  successful  clinical  study  and  management 
of  skin  diseases,  there  are  one  or  two  important  con- 
siderations which  should  never  be  lost  sight  of  hy 
the  practitioner  or  the  student. 

Firstly,  as  to  the  general  character  of  skin  erup- 
tions.— There  is  nothing  really  special  in  their 
pathology.  It  has  been  a  common  remark  that  the 
study  of  skin  diseases  is  bewildering  on  account, 
amongst  other  reasons,  of  the  infinite  A'^ariety  of 
forms  and  aspects  assumed  by  eruptions,  and  the 
multitudinous  names  given  in  consequence.  Until 
lately  there  certainly  was  much  truth  in  such  a 
statement,  but  now  researches  in  cutaneous  patho- 
logy are  fast  clearing  the  path  to  a  more  correct 
knowledge  of  skin  affections,  whilst  difficulties  are 
rapidly  vanishing,  especial  1^^  by  the  breaking  down 
of  those  artificial  distinctions  which  have  so  multi- 
1 


2  INDICATIONS    FOR    THE 

plied  varieties  and  terras.  It  is  now  manifest  that 
similar  morbid  processes  go  on  in-  the  skin  and 
in  other  parts  of  the  body.  Indeed,  day  by  day  it 
is  becoming  more  possible  to  group  skin  diseases 
according  to  tiieir  pathological  affinities  exactly  on 
the  same  plan  as  other  diseases.  This  fact  in  itself 
testifies  abundantly  to  the  clear  insight  already 
gained  into  the  subject,  and  it  also  explains  the 
circumstance  that  the  student  of  to-day,  who  is 
compelled  to  acquire  pathological  knowledge  in 
general,  discovers  that  tlie  stud3'  of  skin  diseases  is 
rendered  comparatively  easy  because  of  the  analogy 
existing  between  the  facts  of  general  and  skin 
patholog}^  He  does  not  find  himself  dealing  with 
strange  topics  or  data,  but  recognizes  familiar 
appearances,  changes,  and  causes,  in  morbid  action. 
It  is  most  important  then  to  understand  that  there 
is  nothing  essentially'  special  in  cutaneous  patho- 
logical changes  as  compared  with  those  which  occur 
in  other  parts. 

Secondlt/,  as  to  the  mode  of  examining  skin  dis- 
eases.— In  diagnosing  a  great  error  is  commonly 
committed  by  attempting  to  recognize  them  from  a 
too  partial  examination  of  the  phenomena  they  pre- 
sent either  to  the  senses  of  the  practitioner  or  in 
their  histories.  Practitioners  and  students,  as  the 
rule,  content  themselves  with  diagnosing  from  sight 
alone ;  they  make  a  venture  at  the  diagnosis  from  the 
aspect  alone,  but  only  to  be  often  signally  wrong. 
Without  a  correct  diagnosis  successful  treatment 


STUDY    OF    SKTN    DISEASES.  3 

cannot  be  confldently  expected,  but  must  be  more 
or  less  chance  work.  In  some,  and  indeed  many 
cases,  no  doubt  the  nature  of  the  disease  can  be  made 
out  correctly  at  once  from  inspection,  and  that  even 
of  a  partial  kind,  inasmuch  as  the  eruption  assumes 
from  the  outset  and  preserves  throughout  its  course 
its  typical  characters.  In  other  instances,  on  the 
contrary,  this  is  difBcult  or  impossible  without 
careful  inspection  of  many  parts  of  the  disease  in 
several  localities  in  a  given  patient,  or  an  inquiry 
into  the  previous  history  of  its  course ;  for  many 
skin  diseases  are  made  up  of  stages,  and,  at  the  time 
of  observation,  these  may  vary  greatly  in  different 
parts,  and  the  tj'pical  characters  may  not  be  dis- 
tinctly recognizable  or  may  be  masked  by  accidental 
concomitants.  And  further,  parts  onl}^  or  stages  of 
diffei'ent  diseases  often  present  a  likeness  to  one 
another  and  may  convey  a  very  imperfect  picture  of 
the  disease.  To  avoid  error,  then,  the  diagnosis 
should  be  based  upon  the  phenomena  or  features 
presented  by  any  given  disease  as  a  whole,  and  not 
upon  any  particular  portion  of  that  disease. 

It  follows,  therefore,  from  what  has  just  been 
said,  that  there  are  two  useful  rules  to  be  observed 
in  making  a  diagnosis.     The  first  is  this : — 

All  diseased  places^  or  as  many  as  possible,  in  a 
patient  should  be  carefully  examined,  and  not  one 
only  or  one  here  and  there,  for  the  simple  reason  that 
the  eruption  may  be  at  very  different  stages  of  devel- 
opment, and  therefore  present  very  diverse  aspects 
in  diff^erent  localities  in  the  same  patient. 


4  INDICATIONS    FOR    THE 

The  object  of  this  examination  is  to  trace  out  the 
origin  and  course  of  the  disease,  and  to  link  togetlier 
the  various  stages  into  a  complete  history  which 
will  answer  in  its  clinical  features  to  an  authorita- 
tive standard  description  of  the  disease  whatever  it 
may  be.  During  this  examination  special  attention 
should  be  directed  to  the  character  of  the  newest 
developments,  and,  if  there  be  none  of  the  kind, 
to  the  extending  edge  of  patches  which  always 
constitutes  the  most  recently  developed  parts  of  the 
disease,  and  therefore  best  portrays  the  primar}' 
lesion.  Complications  are  more  likely  to  be  uu- 
ravelled  bj'  attention  to  this  point. 

The  second  rule  is  this : — 

Where  the  earlier  stages  in  any  given  case  are  nut 
recognizable,  careful  inquiry  should  be  made  into 
the  history  by  interrogation  of  the  patient  as  to  the 
changes  that  have  occurred  before  the  disease  came 
under  observation,  with  a  view  to  discover  its  nature. 

Very  frequently  no  fresh  developments  of  the 
eruption  are  taking  place  and  no  extension  of  a 
patch  has  occurred  for  some  time,  the  malady 
having  become  chronic  and  indolent  and  having  lost 
its  typical  features ;  then  the  only  wa3'  of  making  a 
diagnosis  is  by  observing  this  second  rule.  For 
example,  an  eczema  is  characterized  mainly  by  a 
peculiar  discharge,  but  the  discharging  stage  is 
frequently  over  before  the  case  comes  under  the 
care  of  the  medical  man,  and  the  disease  may 
present  a  dry  and    scaly  appearance,  and   so    be 


STUDY    OF    SKIN    DISEASES.  5 

mistaken  for  psoriasis,  a  fact  of  not  nnfrequent 
occurrence.  And  again  a  disease  esentially  papular 
may  liave  become  inflamed  and  encrusted,  and  its 
true  nature  may  be  overlooked,  unless  the  history 
be  carefully  inquired  into. 

By  the  observance  of  these  two  rules,  the  elemen- 
tary lesion  and  the  characters  of  the  different  stages 
of  any  given  disease,  are  ascertained,  and  with  these 
the  observer  should  form  a  picture  of  the  malady, 
and  so  make  an  accurate  diagnosis,  just  as  the  child 
with  his  dissected  puzzle  puts  together  the  animal 
or  landscape  bit  by  bit,  to  form  the  desired  whole. 

Thirdly^  as  regards  complications. — It  should" 
never  be  forgotten  that  two  or  more  eruptions  may 
occur  together,  and  their  characters  be  mingled  in 
varying  proportions.  Examples  of  this  are  found 
in  the  concurrence  of  urticaria  and  eczema,  of  syphi- 
litic rash  and  chloasma,  of  lichen  and  urticaria,  of 
ecthyma  and  scabies,  of  purpura  and  urticaria,  of 
eczema  and  scabies  or  furunculus,  and  so  on.  The 
fact  here  indicated  should  never  be  lost  sight  of, 
though,  on  the  other  hand,  multiformity  of  eruption 
is  by  no  means  sufficient  evidence,  yet  it  is  sug- 
gestive of  the  coexistence  of  two  or  more  distinct 
diseases ;  especially  if  scabies  and  sj'philis  be  left 
out  of  the  question. 

Fourthly,  as  regards  modifications  of  eruptions. — ■ 

There  are  many  influences  modifying  the  aspect  and 

general   character  and   behavior  of  skin  diseases, 

that  have  to  be  taken  into  account  in  dealing  with 

1* 


6  STUDY    OF    SKIN    DISEASES. 

the  treatraeut.  It  is  necessary  for  tlie  pliysician 
not  only  to  recognize  any  particular  kind  and  form 
of  skin  eruption,  but  to  appreciate  the  part  i)]n3'ed 
by  various  concomitant  conditions  in  the  individual, 
such  as  diathesis,  blood  state,  sjjecial  causes  induc- 
ing an  inflammatory  character  or  leading  to  unusual 
pus  formation  or  undue  chronicity,  and  the  like. 
The  evil  influences  of  such  conditions  must  be 
thwarted,  so  as  to  pave  the  way  for  the  proi>er  ac- 
tion of  curative  measures  directed  against  the  dis- 
ease as  a  disease  in  the  abstract. 

A  few  useful  particulars  or  hints  may  be  intro- 
duced here.  Diseases  of  the  skin  are  spread  or  take 
on  an  inflammatory  character,  or  the  changes  in  the 
skin  are  exaggerated,  by  exposure  to  all  irritating 
agencies,  heat,  cold,  scratching,  the  contact  of  acrid 
substances  of  all  kinds,  as  by  the  handling  of  lime, 
sugar,  soda,  respectively  by  bricklayers,  grocers, 
and  washerwomen.  So,  too,  an  inflammatory  aspect 
is  given  to  eruptions  by  acridities  in  the  blood,  as 
in  gouty  or  rheumatic  subjects,  in  dyspeptics,  and 
in  those  in  whom  the  bile  acids  or  retained  eflfete 
matters  are  present  in  undue  amount  in  the  blood. 
Eruptions  in  strumous  subjects  are  attended  by 
more  or  less  pus  formation  unusual  to  them  under 
other  conditions.  Undue  chronicit}^  is  occasioned 
oftentimes  by  the  existence  of  nervous  or  general 
debility;  for  nature  then  lacks  the  natural  recupe- 
rative power,  and  cannot  exert  it  in  aid  of  the  cure. 

The  questions  of  age,  sex,  occupation,  mode  of 


ELEMENTARY     LESIONS.  7 

life,  and  tlic  general  medical  history  of  tlie  patient, 
have  to  be  considered,  and  will  be  incidentally  re- 
ferred to  in  other  places.  Attention  to  the  four 
indications  already  discussed  will,  however,  be  found 
of  essential  importance  in  the  successful  study  or 
treatment  of  a  skin  disease.  It  may  be  observed, 
however,  as  regards  age,  that  one  essential  difference 
between  the  cutaneous  diseases  of  young  life  as 
compared  with  those  occnyring  in  tlie  middle-aged 
and  old,  consists  in  the  fact  that  the  former  are 
often  the  result  of  imperfect  digestion  and  assimila- 
tion, whereas  the  latter  are  induced  by  mal-influeuces 
connected  with  the  habits  and  occupations  and  wear 
aud  tear  of  adult  life,  and  degeneration  of  structure 
in  the  old,  and  are  modified  by  a  number  of  func- 
tional and  organic  diseases  of  internal  organs,  which 
have  not  had  time  nor  opportunity  to  develop  in 
the  voung. 


SECTION    II. 

ELEMENTARY  LESIONS. 

Tlie  elementary  lesions  are  the  types  of  form  and 
aspect  presented  hy  skin  eruptions.  The  student 
is  required  to  know  these  at  examinations,  and  a 
description  of  them  will  constitute  a  general  outline 
of  the  patholog}^  of  the  skin.  They  are  nine  in 
number,  viz. :  Maculae  or  stains  ;  redness  or  hjper- 
ffimia;  wheals;  papules;  vesicles;  bullje  or  blebs ; 


8  ELEMENTARY    LEST0N8. 

pustules ;  squamai  or  scales ;  and  tubercles  ov  large 
papules. 

Maculsc  or  Slain s  may  be — 

a.  Pigmentary  in  nature  when  they  are  due  to 
the  presence  of  altered  coloring  matter  of 
the  blood.  The  stains  may  be  secondary  to 
other  diseases — e.g.,  syphilis ;  or  physiologi- 
cal— e.g.,  pregnancy;  or  associated  with 
certain  cachexiaj — e.g.,  Addison's  disease 
and  lepros}'.  The}'  may  be  prin\ary  or 
idiopathic,  and  are  generally  left  after  h}'- 
perremia  caused  b}'  irritants. 
6.  Chemical,  as  in  the  case  of  stains  from  iodine, 
silver,  bile  acids,  etc. 

c.  Parasitic,  due  to  the  presence  of  fungus  ele- 
ments— e.  g.,  tinea  versicolor. 

d.  Hemorrhagic — e.g.,  purpura  due  to  extra- 
vasated  blood. 

Redness  or  Hypersemia  may  be  active  (arterial) 
or  passive  (venous).  Active  h3perjemia  consists 
of  redness  removable  b}'  pressure.  It  may  be  punc- 
tiform — e.g.,  strophulus;  or  patchy — e.g.,  roseola; 
it  is  often  accompanied  by  swelling  from  effusion — 
e.g.,  erythema  papulatum ;  by  disordered  sensation 
(pruritis) ;  by  slight  rise  in  temperature ;  it  is 
often  followed  by  desquamation,  and  occasionally 
exudation.  It  is  caused  by  local  irritants,  by 
changes  in  the  blood,  and  by  excitation  of  the 
nerves. 

Wheals  are   raised  h^'peraemic   swellings,  that 


ELEMENTARY     LESIONS.  9 

have  a  palish  centre,  and  rapidly  form  to  as  rapidly 
disappear.  They  are  tyi)ically  portrayed  in  the 
sting  of  the  nettle.  It  is  supposed  that  they  are 
caused  by  sudden  dilatation  of  a  bunch  of  capillary 
vessels  and  escape  of  serosity.  They  are  accom- 
panied by  heat  and  great  tingling.  Some  suppose 
the  vessels  be3ond  the  point  of  dilatation  are  in  a 
state  of  spasm.  Wheals  are  characteristic  of  urti- 
caria. 

Papules^  or  pimples,  are  little  solid  raised  forma- 
tions in  the  skin.  The^^  ma}'  be  due  to  hyperaemia 
of  the  papillae  forming  bright  red  points — e.g.,  in 
strophulus ;  or  may  consist  of  hyper?emic,  turges- 
ccnt,  and  erected  follicles — e.  g.,  lichen  tropicus  or 
prickly  heat ;  or  due  to  deposit  of  Ijmph  or  the 
like  about  the  walls  of  the  follicles — e.g.,  lichen 
planus;  or  are  solid  l^-mph  formations  or  cell 
growths  in  the  derma  proper — e.g.,  lichen,  prurigo, 
S343hilis  ;  or  may  be  due  to  an  epithelial  collection 
in  the  follicles — e.g.,  pityriasis  pilaris;  or  may  be 
formed  by  hypertrophy  of  normal  structure — e.  gr., 
papillary  warts. 

Vesicles  are  upliftings  of  the  cuticle  into  minute 
bladders  by  fluid — sweat  or  serosity ;  they  are 
solitary  or  compound.  Solitary  vesicles  may  be 
due  to  sweat  between  the  strata  of  the  horny 
layer  of  the  cuticle — e.  g.,  sudamina  ;  if  larger 
(bullaj)  by  serosity  between  the  horny  and  mucous 
la3ers  of  the  cuticle — e.g.,  pemphigus.  All  others 
are  compound,  and  the  fluid  is  collected  in  loculi 


10  ELEMENTARY     LESIONS. 

formed  by  the  stretched-out  cells  of  tlic  retc — 
e.g.^  variola,  herpes,  erysipelas,  blister,  eczema. 
Further,  in  sudamina,  blister,  and  pemphigus  the 
fluid  is  sweat  or  serous;  in  variola,  eczema,  and 
herpes,  exudation  and  pus  cells  in  addition  are 
present  in  the  rete,  in  the  papillae,  and  the  corium, 
■which  also  gets  thickened  if  the  inflammation 
becomes  chronic. 

Bullae  are  simj^ly  large  vesicles,  and  their  struc- 
ture the  same.  In  sjphilis  bulhe  may  occur,  and 
then  the  contents  become  sanious,  whilst  ulceration 
is  superadded.  But  usually  the  bulla?  become 
tense  with  clear  contents,  then  their  contents  get 
opalescent,  the  bullaj  become  flaccid  and  shrivel 
away,  leaving  only  a  red  mark,  without  change  in 
the  cutis. 

Pustules  are  elevations  of  the  surface  by  pus 
rapidly  formed.  They  are  accompanied  b^^  more 
inflammation  than  vesicles,  and  by  a  deeper  affec- 
tion of  the  tissues,  but  the  loculi  containing  pus 
are  similar  in  structure  to  those  of  vesicles.  The 
pustules  of  ecthyma  are  large  and  deep  seated,  and 
possess  painful  indurated  bases. 

Squamae  or  Scales  are  formed  of  detached  epi- 
dermic scales.  They  differ  from  crusts,  which  are 
formed  b}'  dried  discharge.  Scaliness  occurs  as  a 
secondary  consequence  in  all  inflammatory  skin 
diseases ;  squamae,  particularly  as  an  essential  part 
of  squamous  inflammation — e.g.,  psoriasis,  pityri- 
asis rubra ;  and  in  hypertrophic  conditions. 


ELEMENTARY    LESIONS.  11 

Tuberculum  is  a  solid  fleshy  lump  in  the  skin, 
formed  by  the  growth  of  new  tissue.  It  is  homolo- 
gous— e.g  ,  fibroma,  keloid,  in  which  the  connective 
tissue  is  involved;  or  heterologous — e.g'., cancer, 
lupus. 

There  are  certain  "  Secondary  Changes"  deserv- 
ing of  notice.     They  are — 

Crusting,  in  which  crusts  form  by  the  drying  up 
of  discharge  either  poured  free  upon  the  surface 
through  the  inflamed  derma — e.g..,  eczema;  or 
from  ruptured  bullae — e.g.,  rupia;  or  discharged 
by  an  ulcerating  surface.  They  may  be  due  to 
sebum  collected  in  masses,  or  to  fungus  elements 
— e.g.,  favus.  Crusts  formed  from  the  escape  of 
serum  are  thin  and  bright  coloured  ;  from  dried 
pus,  thick  and  yellow ;  from  drj'ing  of  bullre,  as  a 
rule,  thin  and  slightl}^  dark  ;  from  drying  of  sanious 
pus  from  ulcers,  thick,  dark  coloured,  and'  heaped 
up ;  from  collected  dried  sebum,  flat,  easily  de- 
tached, and  greasy ;  in  favus,  pulverulent,  honey- 
combed, and  sulphur-yellow. 

Ulceration  is  usuall}'^  the  result  of  cachectic 
inflammation,  such  as  the  strumous  or  sj'philitic ; 
or  of  new  growths  replacing  the  normal  textures, 
and  themselves  softening  and  decaying,  as  in  lupus 
and  cancer;  or  it  follows  the  softening  of  actual 
outgrowths  from  the  skin,  as  in  fibroma  and  3^aws. 

Excoriation  is  the  exposure  of  the  true  skin 
without  its  removal,  and  is  due  to  scratching  or 
rubbing.     Its  seat  is  suggestive — on  the  front  of 


12        CLASSIFICATION,   OR    DIAGNOSTIC 

the  forearms  and  the  thighs — of  scabies,  and  about 
the  clavicles  and  shoulders — of  phthiriasis. 

Scars  are  left  by  traumatic  injuries;  caustics; 
and  by  certain  diseases  whicli  ulcerate,  such  as 
variola,  furunculus  and  anthrax,  pustula  maligna, 
strumous  and  sj'philitic  disease.  They  signify 
that  the  true  skin  has  been  removed,  and  replaced 
by  "  cicatricial  tissue." 


SECTION    III. 

CLASSIFICATION,  OR  DIAGNOSTIC  CHART  OF 
SKIN  DISEASES. 

The  following  list,  or  semi-chart,  conveys  a  good 
general  idea  of  the  various  eruptions  met  witli  in 
the  skin,  and  regarded  from  a  clinical  point  of  view. 
The  list  comprises: — 

1.  Eruptions  occurring  in  connection 
■with  the  acute  specific  or  zymotic  dis- 
eases, including  the  variolous  rash,  roseola  vario- 
losa, vaccinia  and  roseola  vaccinia^  the  rashes  of 
typhus,  typhoid,  rubeola,  rubeola  notha,  scarlatina, 
glanders,  and  farcy,  and  dengue.  These  are  impor- 
tant in  reference  to  the  differential  diagnosis  of 
skin  diseases. 

2.  Eruptions,  the  local  manifestations  of  dia- 
thetic STATES,  comprising  scrofuloderma,  or  scro- 
fulous inflammation;  syphilodermata,  or  syphilitic 
eruptions  ;  leprous  eruptions  ;  frambcesia  or  yaws  ; 


CHART    OF    SKIN    DISEASES.  13 

eruptions  occurring  in  connection  with  endemic 
cachexiae,  such  as  the  Paranghi  disease  of  Ce3-lon, 
etc. 

3.  Local  inflammations,  comprising: — 
Erythematous  inflammation  ;  chief  feature  h^^per- 

ffiraia,  with  or  without  some  slight  consequent  eil'u- 
sion  of  serosity. 

Erythema,  intertrigo,  roseola,  urticaria. 
Catarrhal,  characterized  by  serous  effusion  into 
papillary  la3'er,  running  on  to  sero-purulent  dis- 
charge and  crusting. 
Eczema,  impetigo. 
Plastic,  essentially  papnlar,  due  to  effusion  of 
plastic  l^^mph  into  the  papillary  laj^er,  and  sometimes 
the  deeper  dermic  layer. 
Lichen,  prurigo. 
Bullous,  chief  feature  the  development  of  bullae. 

Herpes,  pemphigus,  hydroa. 
Suppurative,  essential  lesion  pustules,  superficial 
and  painless,  or  deeply  seated  and  painful. 

Impetigo  contagiosa,  ecthyma,  furunculus. 
Squamous,  characterized   by  hyperemia  of  the 
derma,  and  hyperplastic  growth  of  cuticle. 
Pit3'riasis  rubra,  psoriasis. 

4.  Hypertrophic  and  atrophic  diseases : — ■ 
A.  Hypertrophic. 

Epithelial  layers  mainly  affected. 

Pityriasis,  warts,  corns,  xeroderma,  and  ich- 
thyosis. 
2 


14       CLASSIFICATION,    OR    DIAGNOSTIC 

Connective  tissues  of  the  skin  spetiall}'  involved. 
Keloid,  fibroma,  morplioea,  scleroderma. 

B.  Atrojjhic. 
Senile  atrophy,  linear  atroph}',  general  maras- 
mus. 

5.  New^  formations,  the  characteristic  being 
the  growth  of  new  tissue  made  up  of  granulation 
cells,  or  altered  and  proliferating  connective  tissue 
cells. 

Lupus,  cancer,  rodent  ulcer. 

6.  Hsemorrhagic  (cutaneous),  effusion  of  blood, 
uninfluenced  b}'  pressure — in  points  or  patches. 

Pnrpura. 

7.  Neuroses,  in  which  the  nerves  are  primarily 
disordered,  and  there  are  no  organic  changes  at  the 
outset. 

Il^'perfesthesia,  anaesthesia,  pruritus. 

8.  Pigmentary  alterations,  consisting  pri- 
marily of  deposits  or  alteration  of  pigment.  I'ig- 
meutation,  secondary  to  other  diseases,  is  not  in- 
cluded here. 

Melasma,  leucopathia,  xanthoderma,  etc. 

9.  Parasitic  diseases,  comprising: — 

A.  Animal. 

Scabies,  phthiriasis,  eruptions  due  to  gnat 
bites,  fleas,  etc. 

B.  Vegetable. 

Tinea  favosa,  tinea  tonsurans,  tinea  circinata, 
tinea  kerion,  tinea  versicolor,  tinea  sycosis, 
tinea  decalvans,  onychomycosis. 


CHART    OF     SKIN    DISEASES.  15 

10.  Diseases  of  the  glands  and  appendages, 

divisible  into : — 

A.  Diseases  of  the  sweat  glands  and  follicles,  as 
excessive  secretion  (liyperidrosis) ;  dimin- 
ished secretion  (anidrosis) ;  altered  secretion 
(chromidrosis,  osmidrosis) ;  congestive  and 
inflammatory  (miliaria,  sudamina,  lichen  tro- 
picus, strophulus,  dysidrosis,  hydroadenitis) ; 
and  sweat  cysts. 

B.  Diseases  of  the  sebaceous  glands,  as  excessive 
secretion  (seborrhcEa) ;  diminished  secretion 
(asteatodes) ;  altered  secretion,  with  or  with- 
out retention  (allosteatodes,  xanthelasma) ; 
retention  of  secretion  without  inflammation 
(molluscum,  horns)  ;  slight  retention  with  in- 
flammation (acne). 

C.  Diseases  of  the  hair  and  hair  follicles,  as  ex- 
cessive growth  (hairy  naevi,  moles,  hirsuties) ; 
diminished  growth,  constituting  partial  or 
absolute  baldness  (alopecia) ;  textural  altera- 
tion (fragilitas)  ;  inflammation  of  the  follicles 
(sycosis). 

D.  Diseases  of  the  nails,  including:  changes 
occurring  in  S3q5liilis,  lichen  ruber,  general 
eczema,  psoriasis,  pityriasis  rubra,  and 
struma;  inflammation  of  the  matrix,  as  in 
onychia ;  parasitic  disease  termed  onj'cho- 
mycosis,  caused  bj'  the  favus  parasite  or  the 
trichophyton ;  h3-peitrophy,  atroph}^,  and 
corn  of  the  nail. 


16         THE    CAUSES     OF     SKIN     DISEASES. 

There  are  then  ten  groups  of  skin  diseases — viz.: 
the  eruptions  of  the  Acute  SpeeiOc  Diseases ;  Local 
Inflaniinations;  Diathetic  Diseases;  H^'per-  and  A- 
trophic  Disease ;  New  Formations ;  Haeraorrhagic, 
Neurotic,  and  Pigmentary  Diseases ;  Disorders  of 
the  Hair  and  Glands  and  tiieir  Appendages.  Such 
is  the  clinical  classification  that  ma}'  be  given  at  an 
examination.  Ever}'  skin  disease  must  fall  into  one 
of  these  groups,  and  it  soon  becomes  an  easy  matter 
to  refer  any  disease  before  the  observer  to  its  pro- 
per class 

SECTION    IV. 

THE  CAUSES  OF  SKIN  DISEASES. 

In  the  previous  section  a  general  summary  has 
been  given  of  tlie  different  varieties  of  skin  diseases 
in  the  form  of  a  tabular  classification.  In  this 
section  a  sketch  is  furnished  of  the  causes  of  those 
diseases,  and  they  may  be  convenientl}'  ranged 
under  two  heads :  — 

1.  Those  which  act  from  within  the  system  upon 
the  skin,  or  internal  causes. 

2.  Those  which  act  from  without,  or  external 
causes. 

There  are  some  who  think  that  the  latter  are 
much  more  frequently  in  operation  and  much  more 
potent  than  the  former,  but  it  is  ver}'  doubtful  it 
such  is  reallv  the  case. 


THE    CAUSES    OF    SKIN    DISEASES.  IT 

A.  Internal  Causes. — Amongst  these  the  most  im- 
portant are:  a.  Hereditary  tendency  to  a  given 
disease,  such  as  in  the  case  ofichthj'osis  or  psoriasis. 
It  may  give  rise  to  a  purely  local  afTection,  or  to  a 
more  or  less  general  disease — i.  e.,  one  involving  the 
skin  locally  and  the  general  health  as  well.  h.  Blood 
poisoning^  or  impurification,  by  special  animal 
or  vegetable  poisons,  inducing  specific  eruptions, 
as  in  the  acute  specific  diseases,  sjq^hilis,  or  that 
derived  from  eating  shellfish,  etc.;  by  deficient 
excretion  or  the  retention  of  excreta  in  undue  pro- 
portion, biliary,  renal,  or  intestinal  in  nature,  giving 
to  the  blood  an  acrid  character ;  by  long-continued 
dyspepsia,  either  from  dietetic  errors  or  otherwise ; 
by  the  presence  of  medicinal  substances — e.  g.,  potas- 
sium bromide,  belladonna,  or  copaiba;  by  the  accu- 
mulation of  lactic  or  nric  acids,  as  in  rheumatism 
and  gout,  inducing  eruptions  and  imparting  an  in- 
flammatory character  to  them ;  by  poverty  which 
depraves  the  blood  and  leads  to  cachexia ;  by  the 
imperfect  fulfilment  by  organs  of  their  natural 
functions,  as  menstruation,  perspiration,  and  hepatic 
and  renal  disturbance,  c.  Nerve  disturbance,  which 
acts  in  one  of  four  waj^s.  Firstly,  by  inducing 
changes  in  the  calibre  of  the  vessels  by  which  the 
blood  supply  and  fluid  transudation  is  altered,  as  in 
the  Erythcmata.  Secondly,  by  directly  encouraging 
tissue  change,  as  in  herpes  and  prurigo.  Thirdl}', 
by  the  loss  of  control  over  the  skin  nutrition,  which 
follows  from  nervous  debility,  allowing  morbid 
2* 


18         THE    CAUSES    OP    SKIN    DISEASES. 

action  of  all  kinds  in  the  skin  to  take  place  more 
readily.  Fourthly,  by  the  transmission  of  irritation 
through  the  reflex  function  by  which  eruptions  may 
be  excited  or  aggravated,  d.  An  innate  disposition 
in  the  skin  tissues  themselves  to  take  on  a  diseased 
condition.  Tins  is  a  point  on  which  special  stress  is 
laid.  It  is  pretty  certain  that  man}-  diseases  of  the 
skin  must  originate  in  a  disordered  behavior  of  the 
very  tissues  themselves,  and  do  not  necessarily  de- 
pend for  their  cause  upon  any  general  mal-nutrition. 
For  instance,  cancer  is  a  case  in  point;  and  so  also 
wart}-  growths  of  all  kinds,  fibroma,  keloid,  and  even 
lupus,  are  other  illustrations  of  the  same  thing.  In 
sOme  cases  there  is  just  an  excess  of  growth,  a  plus 
state  of  the  nutrition  of  the  tissue  and  nothing  more; 
or  it  ma}'  be  a  minus  condition.  In  other  instances  it 
is  a  perverted  nutrition,  a  deviation  in  tlie  type  of  the 
tissue,  as  in  cutaneous  cancer.  In  fact.  Group  IV., 
and  man}^  of  the  diseases  in  Group  10  of  tlie  clas- 
sification illustrate  this  point.  It  is  asserted  by 
most  writers  that  such  changes — liypertrophy  and 
atrophy — are,  in  realit}',  merely  the  consequence  of 
the  presence  in  the  blood  of  a  greater  or  less  amount 
of  the  pabula  of  the  particular  tissues  affected.  But 
if  these  pabula  be  in  excess,  which  is  unproved,  the 
hypertrophy  would  not  occur  unless  the  tissues  were 
disposed  to  make  use  of  them  fully,  and,  if  such  a 
disposition  existed  in  a  degree  less  than  that  of 
healthy  nutrition,  atrophy  would  result.  So  that, 
after  all,  the  "  formative  capacity"  of  the  tissues 


THE    CAUSES    OF    SKIN    DISEASES.         19 

themselves  is  an  important  element  in  these  plus 
and  minus  states  of  growth,  and  the  explanation 
given  above  may  be  trne,  for  if  the  tissues  them- 
selves exlubit  a  tendency  to  hyperplasia,  nature  will 
answer  the  demand  for  an  increased  supply  of 
pabulum.  In  the  case  of  perverted  nutrition  (hete- 
rologous formation)  the  changes  are  explained  more 
readily  by  a  perversion  of  the  "formative  capacit}'" 
than  by  altered  cliaracter  of  growth,  the  conse- 
quence of  a  supply  of  a  modified  kind  of  pabulum. 
e.  Climacteric  or  endemic  influences  induce  skin 
disorder  by  depraving  the  nutrition  of  the  body 
as  a  whole,  as  in  Elephantiasis  Arabura,  Framboesia, 
etc. 

B.  External  Causes. — Some  of  these  influence  the 
general  health  for  evil,  and  so  dis'order  the  skin  in- 
directly; others  act  directly  upon  the  skin. 

1.  Amongst  the  external  causes  acting  directly 
npon  the  skin, the  most  important  are:  Scratching^ 
which  may  excite  and  always  aggravates  disease, 
and  nia3',  in  contagious  cases,  spread  it  from  place 
to  place,  as  in  scabies  and  contagious  impetigo. 
Local  irritants  of  all  kinds — ex.,  cold,  heat,  friction, 
flannel  Avorn  next  to  the  skin,  irritants,  plasters, 
fluids,  and  applications  of  all  kinds;  irritating  sub- 
stances, such  as  lime,  sugar,  flour,  washing  soda:  pro- 
ducing bricklayers',  bakers',  grocers',  and  washer- 
women's itch ;  unwholesome  handicrafts ;  dyes,  con- 
tusions, animal  and  vegetable  parasites  of  all  kinds; 
medicinal  applications,  and  icant  of  care  of  the  skin 
in  the  dirt}'  and  ill-fed. 


20         THE    CAUSES    OF    SKIN    DISEASES. 

2.  Amongst  the  external  causes  that  act  indi- 
rectly upon  the  skin,  through  their  influence  upon 
the  general  health,  may  be  mentioned:  Want  of 
cleanliness,  climatic  influences,  defective  clothing, 
neglect,  and  the  like ;  animal  poisons  inoculated 
into  the  skin,  etc. 

Clinically,  it  is  of  the  highest  moment  to  be  ac- 
quainted with  the  fact  that,  as  a  rule,  these  several 
causes  not  only  var^-  in  character,  but  do  not  ope- 
rate in  a  solitary  or  individual  wa}'.  To  put  it  in 
another  way:  (1)  these  influences  or  agencies  are, 
in  realit}-,  divisible  into  predisposing^  exciting,  pro- 
ducing^ and  intensifying  causes  ;  and  further  (2) 
the  true  cause  of  the  state  of  any  given  disease  is 
made  up  of  a  number  of  phenomena  or  agencies  in 
combined  operation.  These  are  points  of  great 
practical  importance  in  reference  to  the  treatment 
of  skin  diseases. 

In  reference  to  the  first  point,  it  may  be  said 
that  many  so-called  local  causes  only  predispose, 
though  they  usually  excite,  to  eruption.  For  in- 
stance, take  the  case  of  debilitating  occupations, 
which  render  a  man  much  more  liable  to  be  affected 
b}^  the  handling  of  irritants,  or  the  influence  of 
climate,  by  which  the  system  generally  is  dis- 
ordered with  the  skin,  and  the  latter  so  rendered 
liable  to  disease.  Other  causes  act  as  pure  exci- 
tants, as  when  there  is  a  predisposition  to  a  disease 
— e.g.,  eczema,  and  the  local  irritant  excites  it,  but 
probably  would  not  if  acting  without  the  existing 


THE    CAUSES    OF    SKIN    DISEASES.         21 

predisposition.  Some,  however,  are  really  pro- 
ducers of  disease,  as  in  the  case  of  medical  irritants 
or  circulated  poisons — e.gr,,  malignant  pustule  or 
parasites.  Others  again  only  aggravate  existing 
disease,  as  in  the  case  of  the  wearing  of  flannel,  or 
exposure,  or  scratching. 

In  reference  to  the  second  point,  it  is  indisputable 
that,  in  most  cases,  several  agencies  or  influences 
external  or  internal  in  origin  or  operation,  combine 
to  make  up  the  true  cause  of  a  disease,  and  it  is  the 
duty  of  the  physician  to  recognize  the  fact  and 
analyze  the  cause  correctly.  In  fact,  in  such 
correct  analysis  lies  the  source  of  all  successful 
dermatological  treatment.  Diseases  of  the  skin  are 
very  different  things  as  portraj'ed  on  paper  and  in 
the  consulting-room  from  a  therapeutical  point  of 
view.  A  disease  may  answer  most  perfectly  to  the 
typical  description,  but  the  remedies  ordered  for  its 
cure  may  signally  fail,  because  the  analysis  of  cau- 
sation is  incorrect  or  incomplete.  For  diseases  are 
greatly  modified  as  they  occur  in  different  subjects, 
and  it  is  not  the  uncomplicated  type  that  is  to  be 
dealt  with  in  practice,  but  the  disease  modified  and 
influenced  by  the  many  concomitant  conditions  of 
age,  constitution,  occupation,  etc. 

It  may  be  useful  to  mention  a  few  common  com- 
binations met  with  clinicall3',  which  illustrate  the 
multiform  character  of  the  causation  of  skin 
diseases,  as  seen  in  the  consulting-room.  In  the 
case  of  eruptions  provoked  by  local  irritants,  rcr 


22         TUE    CAUSES    OP    SKIN    DISEASES. 

ferred  to  above,  there  is  very  frequently  debility 
present  which  favors  the  development  of  the  disease, 
and  which  ninst  be  got  rid  of  if  the  eruption  is  to 
get  well,  and  if  it  is  to  be  cured,  in  the  best  way. 
In  fact,  the  skin  of  a  healthy  person  will  mostly 
resist  the  action  of  many  of  the  local  irritants 
specified,  but  cannot  do  so  if  the  subject  be  weak 
and  debilitated ;  so  that  it  is  an  important  point  to 
give  tonics,  as  the  rule,  in  cases  of  eruptions  excited 
by  local  irritants.  Here  there  is  one  simple  com- 
bination of  causes,  debility  and  local  irritants,  in- 
ducing erythema,  eczema,  lichen,  etc.  Other  ex- 
amples readily  occur,  such  as  eczema  in  a  gouty 
subject,  modified  by  neglect  and  scratching;  pso- 
riasis in  a  strumous  subject  in  whom  the  tendency 
to  the  disease  is  hereditary ;  erythema  in  a  rheuma- 
tic subject,  in  connection  with  d3'spepsia ;  eczema 
occurring  in  cooks  exposed  to  the  irritating  in- 
fluence of  the  fire,  whilst  the  patient  also  has  a 
blood  current  charged  with  retained  excreta,  in 
consequence  of  ineflScient  bowel  and  kidney  action ; 
lupus  in  a  scrofulous  subject;  tinea  tonsurans  in  a 
boy  with  persistent  anaemia  and  a  phthisical  ten- 
dency ;  pruritus  in  connection  with  senile  ati'oph}' 
of  the  skin,  liver  derangement,  and  gout.  Other 
examples  might  be  multiplied  almost  indefinitely. 

In  estimating,  therefore,  the  cause  of  any  given 
cutaneous  disease,  attention  must  be  paid  not  only 
to  predisposing  and  exciting  causes,  ))ut  to  coin- 
cident occurrences    and   accidental  concomitants 


DIAGNOSIS.  23 

modifying  such  disorder ;  for  it  is  not  in  the  ab- 
stract that  the  disease  is  to  be  regarded,  but  in  its 
entirety,  and  in  all  its  clinical  features  and  be- 
haviors. The  correct  estimation  of  a  disease  after 
this  fashion  comprises  the  diagnosis,  upon  which 
a  few  remarks  will  be  made  in  the  next  section. 


SECTION  V. 

DIAGNOSIS. 

Firstly. — In  making  a  diagnosis  the  observer 
should  apply  the  rule  laid  down  (Section  I.)  for 
examining  skin  diseases — viz.,  to  scrutinize  the 
whole  of  the  eruption,  not  a  part  only,  and  trace 
carefully'  its  history  to  discover  the  nature  of  its 
beginning,  the  character  of  its  stages,  if  any,  and 
their  transitional  relationship,  and  the  general 
course  of  the  eruption  up  to  the  time  of  observa- 
tion. Secondly. — The  observer  must  proceed  to 
determine  to  which  class  the  disease  belongs, 
according  to  the  principles  laid  down  in  the  chart 
in  Section  III.  Is  it  an  eruption  of  the  Acute 
Specific  Diseases?  Then  the  constitutional  con- 
dition will  be  by  far  tlie  most  pronounced,  the 
patient  more  or  less  prostrated,  the  temperature 
unusually  high,  whilst  the  other  pyrexial  symptoms 
will  be  marked  and  out  of  proportion  to  the  mere 
rash ;  the  access  of  the  malady  will  have  been 
comparatively  sudden,  and  so  on.     Is  the  eruption 


24  DIAGNOSIS. 

essentially  erythematous?  It  must  be  one  of  four 
conditions — viz.,  erythema,  intertrigo,  roseola,  urti- 
caria ;  and  the  reader  is  referred  for  tlie  features  of 
these  to  the  si)ecial  description  in  Part  II.  Is  the 
disorder  accompanied  by  sero-purulent  discharge, 
by  the  development  of  bullae,  by  pustules,  or  by 
squamae  alone  ?  Then  the  disease  is  one  of  those 
comi)rised  under  local  inflammations.  Is  the  erup- 
tion part  of  a  cachexia,  or  some  special  diatlietic 
condition  present?  Then  it  belongs  to  Group  II. 
And  in  a  similar  way  may  H3'pertrophies  or  Out- 
growths of  Tissue,  Atrophies,  New  Formations,- 
Hemorrhagic  Spots,  Neurotic  conditions  without 
organic  changes,  Pigmentary'  alterations.  Parasitic 
diseases,  and  affections  of  the  Glands,  Hair,  and 
Nails,  be  put  under  their  respective  headings.  In 
the  case  of  New  Formations,  the  diagnosis  is  singu- 
larly- easy.  Tiie  3'oungest  student  can  readily 
distinguish  the  new]3--rormed  flesh\'  mass  of  a 
neoplasm  in  the  skin  from  the  ordinary  rapidly 
formed  semi-hjperaemic  inflammator3-  deposit  of  a 
similar  size ;  and  he  knows  practicall3'  that  he  has 
a  case  of  syphiloderma  or  lupus  to  deal  with.  In 
making  a  dianosis,  the  observer  mnst  remember  to 
determine  whether  the  disease  is  or  is  not  com- 
plicated by  another,  as  evidenced  by  a  mixture  of 
characters,  and  to  thoroughly  sift  out  the  nature  of 
an3'  constitutional  modifying  influences.  Thirdly. — 
An  estimate  of  the  immediate  or  exciting  cause  of 
any  given  eruption  is  of  the  first  im]x>rtancc  in  a 


TREATMENT.  25 

complete  diagnosis.  No  doubt,  when  the  observer 
has  been  able  to  put  the  disease  before  him  into 
its  proper  class,  a  pretty  correct  indication  is 
obtained  of  its  causes,  especially  as  regards  Classes 
1,2,4,5,6,9  (Section  III.);  yet,  unfortunately, 
the  difficulty  is  greater  with  the  eruptions  of  the 
commonest  occurrence,  comprised  in  Class  3,  and 
with  those  in  Classes  7  and  10  (B  and  C).  Hence 
the  observer  must  proceed  on  the  lines  laid  down 
in  Section  IV.,  working  out  the  specific  cause,  and 
inquiring  into  the  production  of  the  eruption  from 
within  or  without.  Is  the  cause  an  hereditary 
tendency",  the  result  of  blood  poisoning,  nerve 
disturbance,  a  disposition  in  the  tissues  themselves 
to  take  on  a  diseased  condition,  or  climatic  influ- 
ence ?  Is  the  cause  to  be  sought  in  local  agencies, 
as  detailed  under  B  (Section  IV.)  ?  And  at  the 
same  time  the  observer  will  bear  in  mind  what  has 
been  said  about  the  multiple  character  of  the  causes 
of  skin  diseases.  So  the  diagnosis  will  be  correctly 
worked  out.  The  way  is  now  prepared  for  some 
remarks  on  the  therapeutics  in  the  following  sec- 
tion. 

SECTION    VI. 

TREATMENT  (GENERAL  PRINCIPLES). 

If,  as  has  been  already  stated,  there  is  nothing 
essentially  special  in  the  pathological  changes  that 
occur  in  skin  diseases,  it  follows  that  there  can  be 
3 


26  TBEATMEiNT. 

little  that  is  absolutely  special  in  the  treatment. 
What  differences  there  are  arise  from  the  fact  that 
the  skin  can  be  irritated  directl}^,  and  that  the 
diseased  parts  become  rapidly  dry,  harsh,  cracked, 
etc.,  from  the  constant  exposure  to  the  air,  so  that 
they  need  to  be  kept  protected  and  stipple  by  the 
use  of  moistenwg  applications.  Otherwise  the 
general  principles  of  therapeutics  are  applicable  to 
the  case  of  skin  maladies,  and  it  is  necessary  for 
the  reader  to  mentally  la}'  firm  hold  of  this  fact. 

A  correct  diagnosis  must  precede  successful 
treatment.  When  in  accordance  with  the  rules 
laid  down  a  given  disease  has  been  placed  in  its 
proi)er  clinical  class,  and  the  exciting  and  other 
causes  discovered,  the  proper  kind  of  treatment 
naturally  suggests  itself.  It  may  be  said,  indeed, 
that  the  ten  groups  of  skin  diseases  require  three 
main  methods  of  treatment — viz.,  a  purely  local 
one,  or  one  almost  wholly  general,  or  a  mixed  kind, 
partly  local  and  partly  general.  That  is,  indeed, 
saying  in  other  words  that  skin  diseases  are  made 
up  of  those  essentially  local  in  nature,  those  essen- 
tially general,  and  those  more  or  less  local  in  their 
main  features,  but  influenced  b}' general  conditions. 
In  the  first  category  may  be  placed  Groups  4,  5, 
and  9;  in  the  second  Groups  1  and  2;  and  in  the 
third  Groups  3,  6,  7,  8,  and  10. 

In  dealing  with  the  local  mischief  in  Groups  4 
and  5,  absorbent  or  astringent  remedies  to  promote 
resolution  or  removal  by  caustic  or  surgical  means. 


TREATMENT.  27 

constitute  the  treatment.  In  Group  9  parasiticides 
are  to  be  employed  to  kill  the  insect  or  fungus 
which  produces  the  pariicular  disease  present.  In 
dealing  with  the  components  of  Group  2 — for  I 
need  not  touch  on  Group  1 — specific  remedies  are 
nsed :  in  scrofuloderma,  cod-liver  oil ;  in  syphilis, 
mercury  ;  in  leprosy  and  framboesia,  hygienic  meas- 
ures and  so-called  "  specifics."  So  far  all  is  clear. 
When  we  come  to  the  third  or  mixed  class  of 
cases  indicated  above,  the  principles  of  treatment 
are  more  varied.  Groups  6,  1,  8,  and  most  of  the 
diseases  comprised  in  10,  are  consequent  on  what 
may  be  conveniently  termed  debility,  and  the 
treatment  consists  of  the  use  of  general  tonics,  etc. 
It  is  not  necessary  to  add  more  about  them,  as 
they  are  amongst  the  more  infrequent  of  skin 
maladies.  As  regards,  however,  Group  3,  the  case 
is  different,  for  the  diseases  comprised  in  it  con- 
tain, as  will  be  seen  at  a  glance,  almost  all  the 
ordinary  forms  of  skin  diseases,  and  it  is  amongst 
these  the  greatest  difficulties  are  met  with,  owing 
to  the  many  causes  of  excitation,  aggravation,  and 
modification.  Now  the  diseases  comprised  in  this 
group  are  essentially  inflammatory ;  some  run  a 
course  of  definite  duration,  as  in  herpes  and  roseola, 
and  hence  require  only  watching  to  prevent  inter- 
currences,  or  for  the  alleviation  of  special  symp- 
toms and  conditions,  such  as  pain  or  disfigurement. 
The  majority,  however,  run  an  indefinite  course, 
and  are  to  be  attacked  by  therapeutic  measures, 


28  TREATMENT. 

based  upon  a  consideration  of  the  varying  com- 
bination of  exciting,  aggravating,  or  modifying 
agencies.  The  treatment  must  be  by  local  and 
internal  remeflies. 

As  regards  local  remedies,  there  arc  three  main 
rules  to  be  observed,  viz.:  (I)  whenever  active  hy- 
peraemia  is  present,  be  the  disease  what  it  may,  ap- 
plications of  a  stimulating  nature  should  not  be  used, 
but  the  trA.*atment  should  be  essentiall}'  soolhing^ 
otherwise  the  inflammator}-  S3mj)toms  will  be  in- 
creased, and  the  disease  spread. 

(2)  The  action  upon  the  skin  of  an  external  irri- 
tant— as  scratching — should  be  prevented,  and  the 
air  excluded  from  inflamed  or  excoriated  surfaces, 
especiall}'  b}'  oil-packing  and  otherwise. 

(3)  Not  until  the  stage  of  active  hyperaemia  has 
passed  should  astringents,  stimulating  applications, 
or  revulsives  be  employed.  These,  and  absorbents, 
are  to  be  reserved  for  the  stages  of  vascular  slug- 
gishness and  inflammatory  induration  and  thicken- 
ing. 

As  regards  internal  or  general  remedies,  it  is  pro- 
posed to  indicate  below,  in  as  practical  and  concise 
a  form  as  possible,  the  conditions  which  should  be 
taken  into  consideration  in  framing  the  treatment 
of  such  diseases  as  erythema,  intertrigo,  urticaria, 
eczema,  lichen,  prurigo,  pemphigus,  hydroa,  ecthyma, 
furunculus,  pityriasis  rubra,  and  psoriasis;  and  in- 
flammatorj'  conditions  of  the  glands  and  hair  folli- 
cles, as  acne,  dysidrosis,  and  sycosis,  which  are  ana- 


TREATMENT.  29 

loo-ous  to,  and  only  differ  in  regard  to  their  anatomi- 
cal seat  from,  those  pi'eceding.  This  short  sketch 
or  chart,  inasmncli  as  it  applies  to  the  bulk  of  skin 
diseases,  should  be  used  regularly  in  determining 
the  treatment,  which  must  necessarily  vary  with  the 
different  combinations  of  influencing  agencies  re- 
ferred to.     These  conditions  are : — 

A  Syphilitic  Taint  whicli  tends  to  induce  indu- 
ration from  the  presence  of  syphilitic  tissue  ;  or  ul- 
ceration, cachexia,  and  general  debility  in  eczema, 
psoriasis,  pemphigus,  ecthyma,  acne,  and  intertrigo, 
(infants).  , 

Co??s/i;9a^zon  which  causes  dyspepsia,  liver  torpor 
and  retention  of  excreta,  and  occurs  in  all  forms  of 
skin  diseases. 

Debility^  including  anaemia,  which  retards  re- 
covery from  want  of  recuperative  power  in  the 
system,  all  functions  sharing  in  the  debility.  It  is 
especially  operative  in  furunculus,  eczema,  pity- 
riasis rubra,  pemphigus,  and  ecthyma. 

Diabetes  which  increases  an}'  inflammatory  con- 
dition, favors  phlegmonous  inflammation,  and  leads 
to  freer  development  of  disease,  and  to  chronicit}'. 
Its  influence  is  often  seen  in  eczema,  psoriasis,  in- 
tertrigo in  adults,  furunculus,  and  anthrax. 

Dys2^ej}sia  which  induces  debilit}',  leads  to  liver 
disturbance,  irapurifies  tlie  blood,  and  increases 
hyperemia  by  reflex  action,  as  in  acne,  eczema, 
urticaria,  and  S3'cosis. 

Errors  of  Diet  which  introduce  special  irritative 
3* 


30  TREATMENT. 

substances  into  blood,  cause  dyspepsia,  lead  to 
accumulation  of  nitrogenous  matters  in  system,  to 
liver  disorder,  etc.,  and  complicate  all  forms  of 
inflammatory  eruptions  without  exception. 

Gouty  and  Rheumatic  Diatheses  which  cause 
accumulation  of  uric  and  lactic  acids  and  allied 
compounds  in  blood,  and  give  an  inflammatory 
character  to  disease,  as  seen  in  eczema,  psoriasis, 
lichen,  ecthyma,  sycosis,  and  urticaria. 

Lack  of  Hygiene  which  disposes  to  torpor  of 
skin,  and  favors  the  occurrence  of  morbid  action 
and  disease,  as  seen  in  acne  and  sycosis,  eczema, 
intertrigo,  and  erythema  especially. 

Repression  of  the  special  normal  eliminatory 
functions  (skin  and  menstrual),  which  throws  the 
necessity  of  compensatory  elimination  on  the 
skin,  which  may  fail  to  respond,  and  so  become 
diseased.  In  dependent  parts  this  leads  to  increase 
of  fluid  in  tissues.  It  occurs  in  furunculus,  ecthyma, 
and  eczema. 

Retention  of  Excreta^  from  kidnej-,  liver,  and 
bowel  inactivity,  which  gives  the  blood  an  irritative 
quality  and  aggravates  hypera'mia  in  all  inflam- 
matory skin  diseases.  It  also  leads,  in  the  case  of 
kidney  torpor,  to  increase  of  watery  fluid  in  tis- 
sues, as  in  eczema  of  the  legs. 

Strumous  Diathesis  which  imparts  an  unusual 
■  purulent  character  to  eruptions,  and  favors  the 
implication  of  the  connective  tissues,  as  in  eczema, 
psoriasis,  acne,  and  sj'cosis. 


PAET   II. 

THE  DESCRIPTION"  AND  TREATMENT 
OF  SKIN  DISEASES. 

Acne  is  an  inflammation  of  tlie  sebaceous  glands, 
the  ducts  of  the  glands,  and  the  upper  part  of  the 
hair  follicles.  Mostly  resulting  from  the  retention 
of  tiie  sebum  (comedo),  it  attacks  chiefly  the  face 
and  shoulders,  and  occurs  especially  about  the 
time  of  puberty,  when  the  hair  follicles  are  in  a 
state  of  pliysiological  activity  in  connection  with 
the  free  formation  of  hair,  and  are  in  consequence 
easil}'  disposed  to  become  the  seat  of  disorder. 

The  varieties  are  four  in  number — viz.,  acne 
pimctala,  in  which  there  is  simple  retention  of  dis- 
colored sebum,  called  comedo,  without  any  inflam- 
mation, but  a  certain  amount  of  prominence  form- 
ing a  pimple  ;  acne  simplex,  in  which  slight  perifol- 
licular inflammation  and  occasionally  suppuration 
are  added  to  the  retention  of  sebum  ;  acne  indurata, 
which  is  marked  by  considerable  inflammatorj^ 
induration  at  the  base  of  the  spots,  and  a  certain 
degree  of  suppuration ;  and  lastly,  acne  rosacea, 
characterized  by  a  bright  red  color,  more  or  less 
formation  of  new  connective  tissue  about,  and 
liypertrophy  of  the  glands,  and  by  its  occurrence 


3S  THE    DESCRIPTION     AND 

in  middle-aged  persons  oftentimes  the  subjects  of 
menstrual  disorder. 

The  h3pcrajmia  present  in  acne  is  especially 
intensified  by  djspepsia,  errors  of  diet,  and  local 
irritants.  The  inflammation,  too,  is  modified  by  the 
strumous  and  syphilitic  cachexise,  which  conduce 
to  implication  of  the  surrounding  cellular  tissue 
and  to  suppuration  in  struma,  and  to  induration 
and  ulceration  in  syphilis.  The  condition  denomi- 
nated acne  rosacea  is  scarcely  a  true  acne,  but  con- 
sists of  chronic  hypersemia  of  the  face,  attended  by 
the  formation  of  red  papules,  due  to  the  effusion  of 
lymph  into  the  papillary  layer  of  the  skin.  These 
pai)ules  show  out  from  the  general  reddened  surface 
as  minute  elevations  like  non-suppurating  acne 
spots,  but  they  present  no  central  opening.  The 
occasional  presence  of  true  acne  spots  leads  to  the 
inference  that  the  disease  is  really-  acne. 

Treatment. — The  objects  in  view  a.ve— firstly^  to 
get  rid  of  concomitant  aggravating  conditions  (see 
above);  secondly,  to  remove  the  plugs  of  sebum 
from  the  follicle  (in  comedo  especially)  and  to  lessen 
the  h3'pera}mia ;  thirdly,  to  restore  tone  to  the 
vessels  and  to  the  general  s^'stem  ;  and  fourthly,  to 
promote  the  absorption  of  inflammatory  products. 
In  applying  these  principles,  in  acne  punctata,  hot 
water  bathing  with  friction  with  mild  soap  and  the 
use  of  an  alkaline  wash  (45),  or  if  this  fail  (07), 
cautiously  used,  and  tonics,  constitute  the  proper 
treatment  as   the  rule  (see    Comedo).      In   acne 


TREATMENT     OF    SKIN    DISEASES.  33 

simplex  it  is  ncccssaiy  to  remove  the  dyspepsia,  if 
present,  by  (97)  before  giving  tonics  such  as  (90), 
(101),  or  (108),  or  in  an.iemic  subjects  (94).  Cod- 
liver  oil  must  be  prescribed  for  the  strumous. 
Locally  the  affected  parts  should  be  bathed  witli 
hot  water  twice  a  day,  and  soothed  with  (14)  or 
(74)  to  reduce  the  hyperemia,  and  presently  stimu- 
lated witli  (64)  or  (66)  diluted.  In  acne  indurala 
similar  internal  remedies  are  required  at  first;  or 
if  the  system  be  loaded  (96)  or  (98)  ;  if  much  indu- 
ration (85).  Locally  soothe  as  in  acne  simplex, 
and  subsequently  remove  the  induration  by  the 
use  of  (47),  (60),  or  (66);  or,  if  necessary,  occa- 
sionally touch  each  spot  with  acid  nitrate  of 
mercury.  In  acne  rosacea  it  is  necessary  to  look 
to  the  state  of  the  uterine  functions,  to  remedy 
coexisting  dyspepsia,  debility,  tippling  habits,  etc. 
Internally  (95)  may  be  given  with  advantage ; 
locally  (74)  may  be  used,  with  the  occasional 
application  of  acid  nitrate  of  mercurj'  to  each  spot, 
or  (80)  may  be  applied  each  night.  In  some  cases 
it  is  advisable  to  cut  the  vessels  across  with  a 
lancet,  and  to  apply,  after  the  parts  have  bled, 
collodion  regularly  for  awhile.  In  indolent  cases 
of  extensive  acne  rosacea  and  indurata  (65)  may 
be  used  everj'  night  or  every  other  night. 

Alopecia  or  Baldness  may  be  partial  or  gene- 
ral, hereditary  or  acquired,  idiopathic  or  symp- 
tomatic. When  symptomatic^  the  baldness  is 
usually  a  relative  one,  and  it  results  from  the  dis- 


34  THE     DESCRIPTION    AND 

tnrbance  of  the  nutrition  of  the  part  by  inflammatory 
diseases — e.g.,  eczema;  or  by  blood  diseases — e.g., 
83'philis  ;  or  by  parasites  (see  Tinea) ;  or  from  de- 
bility from  other  special  causes.  When  idiopathic, 
it  results  from  atrophy  of  the  affected  parts,  and 
failure  in  the  reformation  of  hair,  and  then  is  abso- 
lute, usually  taking  the  form  of  circumscribed  areas 
{areata  or  circumscripta),  which  gradually  extend ; 
the  skin  itself  is  white,  less  vascular,  and  less  sensi- 
tive than  usual. 

Treatment. — In  symptomatic  cases  the  treatment 
of  the  alopecia  is  that  of  the  disease  which  induces 
it.  In  the  idiopathic  forms,  where  the  entire  hair 
is  lost,  little  can  be  done  save  by  continuous  stimu- 
lation. When  more  localized,  however,  good  may 
be  effected  by  applying  tinctufe  of  iodine  daily  f(»r 
two  or  three  weeks,  or  rubbing  in  an  ointment  com- 
posed of  two  grains  of  bichloride  of  h3-drarg3'rum  to 
one  ounce  of  lard  for  a  fortnight  or  so,  and  especially 
round  the  edges  of  the  bald  patches ;  then,  or  when 
minute  downy  hairs  appear  (129),  or  better  (130), 
maj'  be  infricted  with  perseverance.  At  the  same 
time  appropriate  tonics  are  to  be  prescribed  should 
there  be  ana?mia  or  debility. 

Anthrax  or  Carbuncle  is  a  phlegmonous  in- 
flammation of  the  skin,  with  necrosis  of  the  cellular 
tissue  and  indolent  suppuration,  the  necrosed  tissue 
forming  man^-  cores  over  the  surface  of  the  car- 
buncle, and  being  discharged,  together  with  i)us, 
through  the  several  corresponding  apertures.     The 


TREATMENT    OF    SKIN    DISEASES.  85 

surrounding  pai'ts  are  brawnj^,  reddened,  and  indu- 
rated, and  the  vessels  plugged.  Carbuncles  are 
painful,  and  exhaust  by  their  irritation  and  accom- 
pan3ang  discharge.  Extensive  sloughing  and  ul- 
ceration may  occur,  and  even  pj'fiemic  sj^mptoms. 
Their  most  common  seat  is  on  the  back  or  back  of 
the  neck,  and  they  maj^  occur  singly  or  one  or  two 
together.  The  subject  of  them  is  usuall}^  much  de- 
pressed in  health,  and  often  of  a  diabetic  habit. 

Treatment  consists  in  the  application,  in  the  early 
stage,  of  caustic  potash,  or  the  employment  of  a 
subcutaneous  or  other  free  crucial  incision,  with 
subsequent  pressure  and  careful  dressing.  Inter- 
nally, the  greatest  attention  should  be  paid  to  sus- 
taining the  strength  of  the  patient,  by  food,  medi- 
cines, or  stimulants,,  as  the  case  may  require. 

Area,  see  Alopecia. 

Atrophia  Cutis  may  be  localized,  and  is  then 
mostly  secondary  to  the  growth  and  disappearance 
of  neoplasmata,  strumous  and  syphilitic  ulceration 
or  degeneration  of  the  skin,  as  in  morphoBa ;  local 
inflammatory  action,  as  in  the  scars  left  b}^  ecthyma, 
zoster,  and  variola ;  and  traumatic  lesions.  It  may 
be  more  or  less  general,  and  then  is  a  part  usually 
of  general  senile  decay ;  or  congenital,  as  in  some 
rare  cases  of  xeroderma.  The  atrophy  may  be 
idiopathic^  and  then  usually  takes  on  the  linear 
form,  and  is  localized  to  certain  parts  of  the  body, 
and  results  probably  from  some  defect  of  innerva- 
tion. 


36  THE    PE80EIPTI0N    AND 

Treatment. — In  the  idiopathic  form,  all  that  can 
be  done  is  to  afford  protection  to  the  part  loeall}', 
and  to  give  appropriate  general  tonics  internally. 

Bakers'  Itch  is  a  term  which  includes  lichen 
agrius  and  chronic  eczema  of  the  hands.  It  is  in- 
duced b}'  the  irritant  action  of  the  flour  used  by 
bakers  (see  Eczema). 

Treatment. — Patients  are  often  considerablj'  out 
of  health,  and  have  a  loaded  system,  though  they 
are  debilitated.  For  such  (95),  or  even  (96),  are  to 
be  given,  and  these  may  be  followed  up  by  tonics, 
such  as  (94)  or  (108).  Locally  the  part  may  be 
first  soothed  by  (76),  or  the  linimentum  calcis,  or, 
if  very  itchy,  by  (40)  or  (42),  and  afterwards,  when 
the  inflammation  is  subdued,  (69)  or  (78)  may  be 
employed. 

Baldness,  see  Alopecia. 

Barbadoes  Leg,  see  Bucnemia. 

Bricklayers'  Itch  is  similar  to  bakers'  itch, 
only  that  it  is  excited  by  the  irritation  of  lime.  It 
requires  similar  treatment  to  bakers'  itch. 

Boils,  see  Furuniculi. 

Bucnemia  Tropica  is  an  hyperplasia  of  the 
connective  tissues,  generally  of  the  lower  limb,  suc- 
ceeding to  repeated  attacks  of  inflammation  of  the 
l3niphatics  of  the  limb.  As  a  consequence  of  the 
I'VTnphatic  obstruction,  a  greater  quantity  of  lymph 
is  retained  in  tlie  connective  tissue  strata  of  the 
skin.  The  disease  may  attack  the  scrotum  (then 
called  Sarcocele)  and  penis,  as  well  as  the  limb, 
and  these  separately  or  at  the  same  time.     In  some 


TREATMENT    OP    SKIN    DISEASES.  37 

cases,  the  lymphatics  are  varicose.  The  cause  of 
the  lymphatic  inflammation  in  ordinaiy  elephanti- 
asis is  probably  clue  to  residence  in  damp  humid 
localities,  especially  such  as  are  tropical  or  malari- 
ous. But  Chyluria  may  coexist  with  the  disease, 
and  chyle-like  fluid  may  exude  from  varicose  lym- 
l)liatics  in  the  enlarged  scrotum  ;  and  as  chyluria 
and  chyloderma  are  associated  with  the  presence  of 
filariae  in  the  lymphatics,  it  has  been  asserted  by 
some,  that  the  form  of  scrotal  disease  in  which 
ch3'le-like  fluid  is  formed  is  only  a  phase  of  ordi- 
nary elephantiasis  of  the  scrotum,  and  that  in  ele- 
phantiasis of  the  leg  or  scrotum  or  other  part,  the 
true  cause  of  the  Ij^mphatic  inflammation  is  the 
irritation  and  obstruction  caused  hy  filariaa  ;  but 
it  has  not  as  j'et  been  proved  that  such  is  the  case. 

Trealmenl. — In  the  earliest  stages,  it  is  that  of 
inflammation  of  the  lymphatics  :  in  the  chronic  state 
friction,  continuous  bandaging,  mercurial  inunction, 
and  finally  ligature  of  the  main  artery  of  the  limb, 
or  excision  of  the  part,  if  the  disease  is  localized  in 
the  scrotum,  have  benefited. 

Bug-eruption. — The  attacks  of  bugs  is  a  com- 
mon cause  of  skin  irritation  in  children,  leading  to 
pruritus  and  urticaria,  conditions  which  are  intensi- 
fied or  ajopear  at  night.  The  bug-bites  may  often 
be  detected  as  rosy  papules  wnth  a  central  punctum. 
The  remed}^  is  to* get  rid  of  the  bugs  from  the 
rooms  or  beds,  whilst  the  pruritus  they  induce  maj^ 
be  relieved  by  alkaline  batlis  (U),  (23),  (43). 
4 


38  TUB    DESCRIPTION     AND 

Cancer,  see  Epithelioma  and  Rodent  Ulcer. 

Carbuncle,  .see  Anthrax. 

Chloasma,  see  Tinea  A-ersicolor. 

Comedones  are  the  small  black-topped  seba- 
ceous plugs,  or  accumulations  of  sebum,  that  are 
found  in  the  early  stage  of  acne  punctata.  The 
form  of  disease  in  which  tiiese  occur  is  called  Co- 
medo. 

Treatment  consists  in  the  free  use  of  hot  water, 
and  if  the  skin  is  irritable,  in  applying  borax  or 
alkaline  washes  (19),  (45),  and  subsequently  when 
the  skin  is  less  irritable,  in  using  tar  soap,  or  soft- 
soap  inunction  cautiously,  to  be  followed  b}'  (H), 
to  allay  irritation,  and  finally  to  stimulate  the 
glands  to  healthy  action  by  such  as  (05),  (67),  or 
03). 

Condylomata  or  "mucous  tubercles"  are  small 
tumors,  generally  sessile,  with  a  circular  outline 
and  somewhat  flattened  top,  occurring  as  a  part  of 
s^'philis.  Thc}^  are  usually  reddi-sh  or  brownish  in 
color  and  spring  np  on  mucous  or  cutaneous  or 
more  often  on  muco-cutaneous  surfaces.  The3'  are 
contagious  and  liable  to  suppurate,  and  contain  the 
peculiar  syphilitic  tissue  in  their  bases.  The  treat- 
ment locally  is  to  keep  them  constantly  clean  and 
dry,  and  to  apply  astringents ;  or  such  mercurial 
preparations  as  blue  ointment,  calomel  powder,  or 
a  lotion  of  bichloride  of  mercury  (gr.  i-ij  to  5j  of 
water). 

Contagious  Impetigo  is  a  disease  quite  dis- 


TREATMENT    OF     SKIN     DISEASES.  39 

tinct  fiom  pustular  eczema.  Sometimes  it  is  quasi- 
epidemic,  but  mostly  sporadic.  It  attacks  children 
only  as  a  rule.  The  eruption  occurs  chiefly  about 
the  face  and  head  and  more  uncommonly  the  hands 
and  body.  It  may  be  ushered  in  by  slight  p^-rexia, 
and  when  fully  developed  consists  of  vesico-pus- 
tules  varying  in  area  from  a  pin's  head  to  a  three- 
penny piece.  The  spots  are  usually  quite  distinct 
the  one  from  the  other,  and  onl}-  run  togetlier  if 
they  are  developed  near  to  one  another.  They  are 
also  superficial — i.  e.,  without  painful  or  hard  bases 
as  in  ectliyma.  The  scabs  that  form  are  light-j'^el- 
low  in  color  and  look  "  as  if  stuck  on,"  and  when 
removed  they  disclose  a  red  surface.  The  diseased 
spots  begin  as  "little  watery  heads."  Each  spot 
runs  a  definite  course  of  a  week  or  ten  days.  The 
isolated  and  discrete  character  of  the  disease  may 
be  masked  in  the  face  and  head,  by  the  excitation 
of  an  eczema,  or  by  the  running  together  of  the 
vesico-pustules,  either  from  scratching  or,  as  before 
stated,  b^'  crowding  together;  but  in  the  latter 
case  the  characteristic  features  seldom  fail  to  pre- 
sent themselves  in  the  majority  of  cases  in  all  j)arts 
of  the  eruption  in  its  early  stages.  The  disease  is 
inocnlable. 

Treatment. — The  scabs  should  be  removed  by 
bathing  or  oiling,  vfhen  it  is  only  necessary  to 
apply  to  the  part  beneath,  a  weak  ammonio-chloride 
of  mercury  ointment  (gr.  v  to  §j)  night  and  morn- 
ing, for  a  few  days,  nnd  tlie  eruption  will  generally 
speedily  disappear. 


40  THE    DESCRIPTION    AND 

Dy sidrosis  is  an  inflammation  of  sweat  follicles, 
which  we  have  described  as  a  distinct  disease,  con- 
sisting firstly  in  an  excessive  secretion  of  perspira- 
tion, which  however  has  a  difficulty  in  escaping 
and  is  retained,  distending  the  sweat  ducts  and 
glands  to  a  greater  or  less  extent.  Of  course  serum 
is  also  poured  out  from  the  inflamed  parts  as  well, 
so  that  the  reaction  of  the  fluid  discharge  is  alka- 
line. It  occurs  in  weakly  jjcrsons  who  are  the  sulv 
jects  of  nervous  debility,  and  often  in  those  who 
readily  and  profusely  perspire.  It  occurs  in  winter 
as  well  as  in  summer.  If  well  marked,  it  may  be 
attended  with  acute  miliaria  of  the  greater  part  of 
the  body,  but  the  characteristic  eruption  is  seen 
about  the  hand.  At  first  the  distended  sweat  fol- 
Jicles  are  seen  as  small  boiled  sago  grain-like  bodies 
imbedded  in  the  skin  of  the  tips,  sides,  and  bases 
of  the  fingers,  and  more  or  less  over  the  palm  of 
the  hand.  As  the  fluid  increases  in  amount  actual 
vesicles  and  bullae  form,  which,  however,  rarely 
discharge,  but  shrivel  up ;  then  the  cuticle  gets 
macerated  and  peels  off,  exposing  a  reddened 
hyperaemic  derma,  but  it  never  discharges  like  an 
eczema^  although  not  unfrequently  it  is  mistaken 
for  it.  The  rash  begins  as  a  distension  of,  and  is  a 
disease  of,  the  sweat  follicles.  It  sometimes  lasts 
a  considerable  time,  until,  in  fact,  the  pf.tient  re- 
covers from  the  debility  before  mentioned  as  so 
often  accompanying  this  disease. 

Treatment. — At  first  diuretics  should  be  given, 


TREATMENT    OP     SKIN    DISEASES.  41 

especially  in  gouty  subjects  or  those  in  whom  tlie 
uriue  is  loaded  or  scant}',  to  be  followed  up  by 
suitable  tonics,  especially  quinine  and  iron.  A  cool 
regimen  should  be  adopted,  hot  drinks  avoided,  or 
whatever  will  increase  the  perspiration.  Locally, 
if  the  body  generally  be  affected  with  miliaria, 
alkaline  baths  may  be  prescribed,  but  the  chief 
thing  is  to  soothe  at  the  outset  by  wrapping  the 
parts  in  some  bland  or  oil}'  substance  such  as 
carron  oil,  and  subsequently  using  a  slight  as- 
tringent, as  (70).  In  some  cases  patients  affected 
by  dysidrosis  are  very  weak,  and  in  these  cases 
the  disease  may  lapse  into  a  semi-chronic  state, 
and  then  a  long  course  of  tonic  treatment  must  be 
adopted. 

Ecthyma  is  characterized  by  the  development 
of  large  isolated  pustules  which  have  hard  and  in- 
flamed bases  and  are  painful.  These  pustules  give 
rise  to  unhealthy  ulcerations  of  a  greater  or  less 
degree,  and  the  crusts  that  form  are  large,  dark,  and 
firml}'  adherent.  This  disease  occurs  Qiainly  in  the 
badly  nourished  and  cachectic.  It  may  be  excited 
by  local  irritants;  in  children  especially  by  scabies; 
in  elderly  persons  by  pediculi.  In  fact,  the  majo- 
rity of  cases  of  ecthyma  are  secondary  to  one  or 
the  other  of  these  two  diseases ;  nevertheless  the 
pustules  may  be  excited  b}'  scratching  alone  in  the 
badl}^  nourished. 

Treatment.  —  If  the   ecthyma  is   secondary   to 
scabies  or  phthiriasis,  these  diseases  must  first  be 
4* 


42  THE    DESCRIPTION    AND 

treated  in  the  usual  vray,  ajici  tlon  Ionics  may  be 
administered  subsequently,  wbeu  the  ecthyma  will 
disappear.  It  may  be  necessary  to  apply  locally 
(35)  or  (GO)  to  heal  the  ulcerations.  If  the  ecth^Mna 
be  idiopathic  it  will  probably  be  desirable  to  give 
aperients  and  rectify  existing  cachexia  or  debility 
by  good  food  and  tonics,  such  as  (92  ,  (95),  (103) 
with  or  without  cod-liver  oil,  applying  the  local 
remedies  mentioned  above.  If  there  be  marked  ul- 
ceration the  sores  may  be  cleansed  by  two  or  three 
applications  of  iodide  of  starch  (52)  or  iodoform, 
and  subsequently  dressed  with  (28),  (79),  or  (81). 
Eczema  is  an  inflammation  of  the  skin  character- 
ized by  sero-purulent  discharge  which  stiffens  linen 
and  dries  into  thin,  yellow  crusts;  it  is,  in  fact,  a 
catarrhal  inflammation  of  the  skin.  It  begins  by  a 
serous  effusion  into  the  papillary  layer  of  the  skin. 
The  effused  fluid  finds  its  way  into  the  rete,  uplifts 
the  cuticle  into  vesiculation,  and  escapes  free  upon 
the  surface,  thus  constituting  the  discharge  which 
continues  a  greater  or  less  time.  Coincidently  with 
its  escape  the  fluid,  which  contains  much  fibrin,  be- 
comes more  or  less  purulent,  and  there  is  a  large 
amount  of  inflammatory  cell-growth  in  the  inter- 
stices of  the  stretched-out  rete  cells  and  in  the  tissue 
of  the  papillary  layer.  If  the  disease  becomes 
chronic  the  cutis  is  altered  by  chronic  inflammatory 
induration  to  a  varying  depth.  Eczema,  therefore, 
begins  as  a  "  serous  catarrh,"  and  is  followed  by  sup- 
piuation  and  inflammatory  infiltration  into  the  skin. 


TREATMENT    OF    SKIN     DISEASES.  43 

Some  think  that  eczeuia  does  not  necessarily 
discliarge,  but  tliis  error  probably  has  arisen  Irom 
the  fact  that  many  other  diseases  have  beei)  included 
under  the  term  eczema,  such  as  parasitic  eruptions, 
lichen,  and  pityriasis.  These  do  not  discharge,  and 
hence  the  statement  that  eczema  is  not  necessarily 
accompanied  by  discharge  :  but  it  is  important  to 
remember  that  in  true  eczema  tliere  is  always  "sero- 
purulent"  fluid  effused  externally. 

There  are  three  varieties  of  eczema — viz.:  (I) 
E.  simplex^  which  is  generally  localized  to  one  or 
two  places,  and  consists  at  first  of  crowded  vesicles 
seated  on  a  red  base,  which,  Avlien  they  rupture, 
give  place  to  a  red  discharging  and  then  crusted 
patch.  It  is  not  attended  by  any  marked  general 
disturbance  of  tlie  system,  though  perhaps  by 
debility,  and  is  frequently  excited  liy  local  irritants 
such  as  heat,  cold,  scratching,  irritant  dyes,  etc. 

(2)  E.  ruhriivi^  wliich  is  the  inflammatory  form 
and  is  attended  hy  more  or  less  constitutional  dis- 
turbance and  by  gouty  or  dyspeptic  symptoms. 
In  this  form  the  local  inflammatory  signs  are  very 
marked,  that  is  to  say,  the  parts  are  hot,  swollen, 
tender,  itchy,  excoriated,  and  they  discharge  and 
crust.  This  eruption  often  attacks  the  flexure  of 
the  joints,  especialh-  at  the  elbows,  knees,  and  axillae. 

(3)  E.  impetiginodes  or  pustulosum,  which  is  cha- 
racterized especially  by  the  free  formation  of  pus, 
free  discharge,  and  free  yellow  crusting.  It  is 
mostly  observed  in  strumous  subjects,  especially  in 


44  THE    DESCRIPTION     AND 

such  children  when  badly  nourished  and  the  victims 
of  bad  hygiene.  These  varieties  occur  in  different 
situations  on  the  body.  Each  variety  has  its  stage 
of  erythema,  papulation,  vesiculation,  and  pustula- 
tion,  and  "discharge."  These  atage.s  have  been 
often  made  into  varieties  of  eczema,  a  proceeding 
at  once  unphilosophical  and  unclinical. 

Treatment — In  E.  simplex  an}'  causes  of  local 
irritation  are  to  he  removed,  and  llie  part  protected 
locally  b}^  dusting  it  over  with  such  as  (48  or  49), 
or  (14)  may  be  applied.  This  should  be  followed 
up  by  (7G) ;  whilst  intei-nally  quinine  and  iron  (109) 
is  given,  since  the  outbreak  or  its  persistence  is 
very  often  favored  by  debility.  E.ruhrum  requires 
more  active  treatment.  Any  gouty  tendency  must 
be  carefully  met  by  appropriate  dietetic  and  other 
remedies,  all  stimulants  being  at  first  avoided.  The 
part  locally  is  to  be  soothed  by  absorbent  powders, 
or  bathing  with  poppj'  water,  and  subsequently 
dressed  with  lininientumaquacalcis,or  should  there 
be  much  burning  (18),  (41),  or  (74).  Sometimes, 
indeed,  all  the  remedies  will  fail  until  a  loaded  sjs- 
tem  has  been  relieved  by  aperients  or  excess  of  acid 
generated  in  the  system  be  corrected,  or  dyspejisia 
remedied.  When  the  part  affected  is  less  irritable 
and  red  (C2)  or  (76)  ma}'  be  employed  with  tonics, 
especially  arsenic,  with  alkalies,  iron,  or  quinine 
(90),  (107),  (108).  If  the  part  become  much 
thickened  and  indolent,  an  alterative  mercurial 
course  with  bark  will  be  found  beuelk;ial,  at  the 


TREATMENT    OF    SKIN    DISEASES.  45 

same  time  that  weak  mercurial  ointments  are  applied 
(fiO),  to  be  followed  in  the  still  more  chronic  cases 
by  blistering,  if  need  be.  E.  impeMginodes  requires 
the  internal  use  of  cod-liver  oil,  iron,  and  quinine, 
"with  suitable  food,  and  locally  the  application  at 
the  outset  of  simple  oil  to  free  the  part  from  crusts, 
followed  by  the  linimentum  aq.  calcis,  and  then  a 
weak  white  precipitate  ointment,  as  for  instance  gr. 
iij  to  the  5j  or  (02). 

In  addition,  certain  local  varieties  are  described 
which  it  will  be  desirable  perhaps  to  mention  here. 
E.  capitis  is  almost  synon3nnous  with  E.  infantile. 
The  child  will  be  found  pale,  and  very  likely  more 
or  less  cachectic.  Bad  or  insufficient  food  is  at  the 
bottom  of  the  majority  of  such  cases,  and  the 
remedies  required  are  better  food,  cod-liver  oil, 
arsenic,  and  steel  wine.  Cleanliness  and  the  use 
locally  of  the  remedies  stated  to  be  appropriate  for 
E.  impetiginodes  must  be  carried  out,  for  E.  infantile 
and  E.  capitis  take  on  the  characters  for  the  most 
part  of  that  variety,  though  occasionally  those  of 
E.  rubrum.  Should  there  be  any  difficultj^  in  re- 
moving the  crusts  the  head  or  face  may  be  kept 
soaked  in  oil  imtil  they  are  loosened  and  detached. 
In  the  adult,  E.  capitis  occurs  in  the  gouty, 
and  requires  similar  treatment  to  E.  rubrum. 
E.  mammae  is  frequently  excited  by  scabies. 
E.  manuum  et  pedum  and  E.  genitale  are  ex- 
amples of  E.  rubrum.  The  former  is  often  excited 
by  flour  in  bakers,  by  sugar  in  grocers,  and  by  soda 


46  THE    DESCRIPTION    AND 

in  washerwomen.  E.  genilale  is  beneGted  mostly 
by  the  use  of  (74) ;  E.  maniium  by  the  remedies 
adapted  for  E.  rubrum ;  E.  jjedum  b}-  rest,  great 
cleanliness,  and  absorbent  powders,  followed  by 
carbolic  lotion,  and  finally  strapping  with  emplas- 
trum  diachyli.  In  eczema  of  the  legs,  if  there  be 
much  oedematous  infiltration  the  liberal  exhibition 
of  diuretics  in  conjunction  with  rest,  careful  bandag- 
ing, and  the  use  of  (76)  or  a  weak  mercurial  oint- 
ment, is  all  that  is  needed  to  effect  a  cure ;  though 
often  tonics  and  good  feeding  are  very  useful  ad- 
juncts. Other  remedies  will  be  found  on  reference 
to  the  cutaneous  pliarmacopoeia. 

Elephantiasis. — Tiiis  tennis  used  as  a  generic 
one  for  two  distinct  diseases:  the  one  is  the  E. 
Arabuv}^  or  tropical  big  leg,  or  Elephant  leg  (see 
Bucneraia) ;  the  other  is  the  E.  Grsevoj-um^  or  the 
true  leprosy.  E.  Grsecorum  is  observed  in  two 
chief  forms — viz.,  tubercular  and  the  anaesthetic. 
The  tubercular  form  is  known  in  its  full}^  developed 
stage  by  three  sets  of  S3'mptoms,  (a)  discoloration 
of  the  skin,  of  a  light  coffee  hue ;  (6)  deposit  of  a 
new  growth  in  the  skin  in  the  form  of  dull  red 
tubercles  or  infiltrations;  and  (c)  amesthesia  of  dif- 
ferent parts,  especially  the  extremities,  due  to  the 
deposit  about  the  superficial  nerve-trunks,  of  the 
same  new  growth  as  that  which  invades  the  skin. 
The  skin  deposit  is  chiefly  found  about  the  face  and 
ears,  so  that  the  eyebrows,  cheeks,  foreiiead,  nose, 
and  its  alaj,  being  greatly  thickened,  give  the  conn- 


TREATMENT    OP    SKIN    DISEASES.  47 

tenailce  a  leonine  appearance.  In  the  anaesthetiG 
form  the  deposit  in  the  skin  is  not  so  marked,  but 
anaesthesia  is  well  developed,  and  eruptions  of  bullaj 
which  leave  behind  atrophous  spots,  and  also  dull 
quasi-psoriatic  but  anaesthetic  circular  spots  of 
eruption  are  observed.  The  hands  are  often  dis- 
torted, and  the  fingers  contracted,  so  that  the  hand 
assumes  a  claw-like  aspect. 

Epithelioma,  or  Epithelial  Cancer. — This  affec- 
tion occurs  in  elderly  persons,  and  attacks  by  pre- 
ference the  lower  lip.  It  begins  as  a  hard  lump, 
which  makes  the  lip  feel  swollen  and  '•  pouty." 
This  lump  soon  cracks  in  tiie  centre  from  the 
setting  in  of  ulceration  ;  and  when  this  takes  place 
the  progress  of  the  disease  is  often  very  rapid. 
The  ulcer,  which  is  now  soon  produced,  is  foul, 
and  its  edges  everted,  indurated,  and  luidermined. 
The  glands  under  the  jaw  are  enlarged  and  in- 
durated. The  treatment  consists  in  excision.  For 
the  variety  denominated  Rodent  Ulcer  {see  further 
on). 

Erythema,  or  simply  redness  (hyperaeraia). — 
Redness  may  form  a  part  of  very  many  dissimilar 
diseases,  all  those,  in  fact,  in  which  inflammation 
or  active  congestion  occurs.  Reference  is  here 
made,  however,  particularly  to  erythemata,  which 
in  themselves  constitute  the  condition  or  disease 
requiring  treatment.     There  are  two  classes. 

The  first  group  of  erythema  cases  includes  all 
those  instances  of  hyperemia  which  are  excited  by 


48  THE    DESCRIPTION    AND 

local  irritants  of  various  kinds,  as  parasites,  heat, 
cold,  friction,  scratching,  flannel,  etc.,  and  also  com- 
prises such  as  are  induced  by  tlie  rubbing  together 
of  two  folds  of  skin  (intertrigo),  and  are  accom- 
panied l)y  a  muciform  discharge. 

The  treatment  of  these  cases  consists  in  removing 
all  local  causes  of  irritation,  and  simply  soothing 
the  part  by  such  remedies  as  (13),  (14),  (3G),  (74), 
followed  by  (10),  (39),  or  (72).  In  intertrigo  (48) 
and  (49)  are  specially  useful ;  and  in  some  cases  it 
is  necessary  to  give  children  tonics,  particularly 
steel  wine  and  cod-liver  oil.  In  the  intertrigo  of 
old  and  fat  people  diuretics  and  alkalies,  followed 
by  tonics  and  dressing  the  parts  continuously  with 
(13)  or  (7G),  is  a  good  mode  of  treatment. 

The  second  group  of  cases  includes  the  erythe- 
mata  connected  with  gejieral  p3rexia,  and  often 
with  a  rheumatic  diathesis.  There  is  rather  more 
swelling  than  in  the  slighter  forms,  and  a  certain 
amount  of  effusion,  so  that  the  erythema  runs  on  to 
papulation  or  the  formation  of  irregular,  and  some- 
times large  nodular  swellings ;  hence  the  terms  E. 
papulatitm,  E.  tuberculatum,  and  E.  nodosum,  and 
E.  mnlliforme,  which  latter  is  used  by  Hebrato  in- 
clude all  the  forms  indicated  by  the  preceding  terms. 
Generally  the  rashes  designated  by  these  terms  have 
a  more  or  less  acute  onset,  ushered  in  by  headache, 
malaise,  and  the  like  sj'mptoms,  and  then  hyperaamic 
blotches  appear  about  the  hands,  arms,  legs,  or 
trunk,  and  the  blotches  may  get  more  or  less  un- 


Til  EAT  ME  NT    OF     SKIN     DISEASES.  49 

even  or  "knotty"  from  effusion,  and  a  purplish 
tint  quickly  develops,  especiall}^  at  the  edges  of  the 
patches;  and  finally  the  whole  thing  in  a  few  days 
fades  away  with  changes  of  color,  like  a  bruise. 
E.  nodosum  occurs  about  the  leg  as  oblong  tuberose 
swellings  about  the  size  of  a  walnut,  or  even  much 
larger,  with  a  bluish  periphery  and  quasi  boggy 
feel  in  the  centre.  Rlieumatic  pains  accompan3' 
this  forms  of  erytliema. 

The  treatment  of  the  members  of  this  second 
group  in  the  slighter  forms  consists  in  giving  mild 
aperient  salines,  followed  l)^'  quinine,  whilst  locally 
some  simple  astringent  wash,  such  as  (^74)  or  (19), 
may  be  applied.  In  the  severer  cases  it  may  be 
necessary  to  relieve  a  loaded  state  of  system  by  (9.^) 
or  (96),  before  giving  quinine,  and  locally  to  use 
similar  measures  as  in  the  less  severe  forms,  or  apply 
powders,  such  as  (48)  or  (49  . 

Favus,  see  Tinea  favosa. 

Fibroma  is  characterized  b}'  the  occurrence  of 
outgrowths  of  fibrous  tissue,  covered  b}^  integument 
of  ordinary  aspectand  feel.  These  tumors  after  a 
time  become  pedunculated.  Their  structure  is  that 
of  a  lax  connective  tissue,  peculiarly  rich  in  cells  at 
certain  parts.  Sometimes  the  tumors  show  a  dis- 
position to  ulcerate,  and  throw  up  exuberant  granu- 
lations. 

Treatment. — If  it  be  important  that  the  tumors 
should  be  got  rid  of,  they  may  be  removed  by  the 
knife  or  tlie  ligature. 
5 


60  THE    DESCRIPTION    AND 

Fish  Skin  Disease,  see  Ichthyosis. 

Follicular  HypersBinia  is  a  common  accom- 
paniment of  man}-  diseases,  and  particniarly  of  those 
attended  by  pruritus,  for  in  these  it  is  readily  ex- 
cited b}"^  scratching,  as  in  scabies,  eczema,  and 
phthiriasis.  It  gives  rise  to  red  papules,  whicli  are 
seen  to  be  seated  at  the  hair  follicles  in  part,  and 
partly  to  be  hypertemic  papillai,  erroneousl}'  saiil  to 
constitute  lichen.  The  condition  demands  soothing 
remedies. 

Fungi. — For  the  names  of  the  several  fungi 
causing  parasitic  diseases,  see  Tinea. 

Furunculus. — It  is  scarcely  necessary  that 
"boils"  should  be  discussed  in  any  considerable 
detail  in  this  place.  They  are  usually  described  as 
rounded,  painful,  circumscribed  inflammations  of 
the  skin,  involving  the  connective  tissue,  and  there- 
fore more  or  less  deeply  seated,  with  hard,  indu- 
rated, and  inflamed  bases.  Slow  suppuration  goes 
on,  and  the  central  portion  sloughs  out,  and  consti- 
tutes what  is  called  the  "core."  In  reality  the 
anatomical  seat  of  boils,  in  the  majority  of  cases,  i& 
a  hair  follicle  or  the  attached  sebaceous  gland,  with 
more  or  less  participation  of  the  cellular  tissue 
around.  In  some  cases  the  follicular  origin  of  boils 
cSKnot  be  made  out,  hence  the  division  into  folli- 
cular and  cellular  tissue  boils.  It  is  open  to  ques- 
tion whether  the  "core"  be  always  an  "exudation," 
or  a  gland  which  has  died  in  consequence  of  the  in- 
flammation.    "When  a  boil  forms,  pain  is  first  felt. 


TREATMENT    OP    SKIN     DISEASES.  51 

and  then  a  lump  accompanied  by  tension  and  red- 
ness: this  enlarges  and  snppurates.  In  "cellular 
tissue  boils"  gangrene  may  occur.  These  are  found 
mostly  on  the  scalp,  neck,  limbs,  and  especially  the 
thighs  of  marasmic  adults,  and  often  children. 
Boils  occur  in  those  whose  vitalit}^  is  depressed  by 
defective  or  depraved  living,  mal-hygiene,  or  expo- 
sure :  also  in  those  whose  blood  current  is  charged 
with  nitrogenous  waste  products,  and  in  diabetic 
patients.  An  exclusive  meat  diet,  stale  or  unsound 
meat,  over-fatigue  and  exercise  are  other  excitants. 
Local  irritants  excite  their  formation,  and  they  may 
accompany  disease  in  which  scratching  is  freely 
practised,  as  in  scabies,  prurigo,  eczema,  phthiriasis, 
etc.  Boils  may  be  epidemic,  and  then  occur  often- 
times when  erysipelas  is  rife. 

Treatment. — The  formulae  useful  for  lioils  are 
specially  (95),  (9(5),  (108),  and  the  mineral  acids, 
internally,  and  (35),  (^9),  and  gl3-cerine  of  bella- 
donna externally.  Patients  with  boils  should  have 
a  carefully  regulated  diet,  and  obtain  fresh  air  by 
change  to  the  seaside  or  of  occupation.  Fresh  yeast 
taken  in  tablespoonful  doses  three  times  a  day  is 
often  very  efficacious.  In  very  debilitated  persons 
the  free  exhibition  of  red  wine  or  porter  may  effect 
the  dispersion  of  the  furunculi.  Some  practitioners 
find  great  benefit  from  the  use  of  carbolic  acid,  or 
acid  nitrate  of  mercury  to  the  boils  to  absorb  them. 

Grocers'  Itch  is  similar  to  Bakers'  itch,  only 
that  it  is  caused  by  the  irritant  action  of  sugar. 


52  THE    DESCRIPTION    AND 

Gutta  rosacea,  sfee  Acne  rosacea. 

Herpes  is  characterized  b}'  the  occcurrence  in 
circumscribed  patches  of  one  or  more  groups  of 
vesicles,  seated  u^wn  an  inflamed  base.  The  develop- 
ment of  tlie  disease  is  attended  with  smarting  and 
tension,  if  not  acute  pain,  and  pyrexia  is  often  pre- 
sent. Thevesicles  are  distinct, large,  and  chambered. 
They  do  not  burst,  but  the  transparent  contents  be- 
come milk}',  and  they  then  dry  up,  forming  light 
crusts  that  fall  in  a  few  days,  leaving  only  a  slight 
reddish  stain  behind.  Each  crop  of  vesicles  runs  a 
definite  course.  Herpes  maj"^  be  symptomatic  or 
idiopathic.  The  former  kind  occurs  in  the  course 
of  febrile  disturbances  of  different  kinds ;  the  latter 
may  be  general  or  local.  There  is  a  general  form 
of  rare  occurrence,  beginning  by  pyrexia,  followed 
b}'  the  development  of  herpes  on  the  skin  and  the 
inside  of  the  mouth  and  throat.  The  disease  lasts 
ten  days  or  so.  The  localized  form  is  commonly 
met  with  about  the  lips,  prepuce,  and  the  course  of 
one  or  more  intercostal  nerves.  According  to  its 
situation,  form,  and  appearance,  so  various  designa- 
tions have  been  applied.  Thus,  one  form  is  generally 
known  as  H.  zoster  or  shinyles,  and  is  made  up  of 
several  patches  or  collections  of  ordinary  herpes, 
distributed  along  the  course  of  a  nerve,  and  tini- 
lateral  in  its  extent.  When  there  is  a  central  vesi- 
cle with  a  surrounding  ring  of  herpes,  and  two  or 
more  circles  of  colors  like  those  presented  by  a 
fading  bruise,  the  form  is  called  U.  iria,  and  is  some- 


T  R  K  A  T  M  E  N  T    OF     SKIN     DISEASES.         53 

times  seen  on  the  back  of  the  hand.  If  the  disease 
take  simply  a  circular  form,  it  is  often  staled  H. 
circinatus. 

Treatment This   consists    in    applying    some 

simple  soothing  unguent,  and  exhibiting  salines,  fol- 
lowed by  quinine  if  need  be.  It  is  necessary  in  lierpes 
zoster  to  protect  the  eruption  from  rubbing  and 
irritation  by  dusting  with  (48),  (49),  or  covering 
the  part  with  cotton-wool.  Sometimes  considerable 
pain  and  discomfort  are  left  by  the  eruption,  and 
relief  may  be  given  by  morphia  ointment,  opiate 
poultices,  subcutaneous  injection,  or  quinine  in  large 
doses. 

Hydroa  is  a  term  much  misused.  It  has  been 
applied  particularly'  by  English  and  French  writers 
to  Herpes  iris,  and  the  bullous  eruptions  (?)  pro- 
duced by  iodide  of  potassium.  It  was  given  by 
Bazin  originally  to  a  disease  which  stands  midway 
between  herpes  and  pemphigus,  and  occurs  in 
arthritic  (gouty)  people,  and  attacks  the  cutaneous 
and  mucous  surfaces.  It  lasts  two  to  four  weeks, 
is  apt  to  recur  and  to  become  chronic,  and  appears 
mostly  in  the  spring.  In  some  cases  there  are  vesi- 
cles (H.  vesiculeucc)  scattered  over  the  backs  of  the 
hands,  wrists,  and  about  the  knees,  and  also  the 
mouth,  developed  out  of  red  papules.  In  other 
cases  the  vesicles  are  varioliform  (IT.  vaccini- 
forme) ;  in  others  there  are  small  bullae  of  diflferent 
sizes,  but  none  above  that  of  a  split  pea,  these  bullae 
being  often  grouped.  In  fact,  there  are  transitional 
5* 


54  THE    DESCRIPTION    AND 

stages  between  minute  vesicles  on  a  red  l)ase  and 
patches  of  herpes,  there  being  frequently  a  mixed 
condition.  The  treatment  consists  in  defeating 
the  ill  effects  of  worr}-,  anxiet}',  and  depression;  in 
regulating  the  diet,  prescribing  change  of  air,  and 
tonics,  especially  quinine. 

Hydroadenitis  is  an  inflammation  of  the  sweat 
glands — a  condition  that  commences  by  the  appear- 
ance of  small  lumpy  swellings  like  blind  boils,  but 
which  do  not  suppurate,  though  remaining  some 
time  painful,  tender,  enlarged,  and  of  a  dull  red 
color,  like  huge  acne  indnrata  spots,  only  that  there 
is  no  central  pustular  point  or  follicular  orifice. 

Treatment. — This  consists  in  allaying  the  local 
inflammation  by  ordinary  measures,  and  subse- 
quently painting  with  collodion,  or  stimulating  the 
places  when  indolent  with  the  application  of  the 
acid  nitrate  of  mercury;  or,  should  this  not  suc- 
ceed, subcutaneous  puncture  ma}'  be  emplo3ed. 

Hyperidrosis,  or  excessive  sweating,  frequently 
comes  under  our  notice  in  a  variety  of  diseases.  It 
is  said  to  be  a  "critical"  occurrence  in  certain  fevers 
at  the  time  of  convalescence,  and  is  common  as  a 
part  of  hectic  fever.  It  ma}'  be  a  natural  defect, 
and  often  occurs  about  the  feet  and  hands  of  certain 
people. 

Treatment. — In  the  class  of  cases  mentioned  im- 
mediately above,  a  general  tonic  plan  of  treatment 
must  be  adopted,  with  the  utmost  cleanliness,  and 
some  such  local  application  as  belladonna  or  alum. 


TREATMENT    OP     SKIN     DISEASES.  55 

Sliould  the  sweat  have  macerated  the  cuticle  be- 
tween the  toes  and  excited  an  eczema,  the  parts 
must  be  constantly  bathed,  some  absorbent  powder 
used,  as  (48),  (49),  and  then  such  as  (10),  (12),  (14), 
(U),  etc. 

Ichthyosis  is  characterized  by  the  presence  on 
different  parts  of  the  body  of  an  incrustation  of 
blackish  hue,  resembling  masses  of  dried  mud  caked 
on  the  surface.  This  caking  stands  out  from  the 
level  of  the  skin  some  two  or  more  lines,  and  is 
pretty  firmly  adherent.  It  can,  however,  be  broken 
up  into  little  squarish  masses.  The  incrustation 
covers  a  var3'ing  extent  of  surface  either  on  a  leg, 
arm,  knee,  or  shoulder.  Beneath  the  masses  the 
skin  is  dry  and  shrivelled ;  in  some  places  the  pa- 
pillae are  hypertrophied,  whilst  in  others  the  orifices 
of  the  sebaceous  glands  are  very  distinct,  and  into 
them  are  fitted  little  plugs  of  epithelial  and  fisitty 
matter — projecting  from  the  under  surface  of  the 
cake.  These  changes  are  accompanied  by  a  general 
cachectic  state  of  the  skin,  which  in  the  parts  not 
incrusted  is  dry,  harsh,  dirty  looking,  scaly,  and 
not  perspiring.  The  disease  is  mostly  congenital, 
or  it  develops  soon  after  birth.  The  microscope 
discloses  hypertrophy  of  the  skin,  the  papillje  espe- 
cially being  enlarged  and  elongated  and  covered 
with  very  numerous  strata  of  cuticular  scales.  The 
latter,  together  with  sebum,  make  up  the  caked 
masses.  A  slighter  form  of  the  disease  in  which 
the  surface  is  dry,  harsh,  dirty  looking,  and  more 


5fi  THE    DE8CEIPT10N    AND 

or  less  inelastic  and  scaly,  is  called  xeroderma^  but 
both  tliese  conditions  are  phases  of  one  and  the 
same  disease,  and  often  concur. 

Treatment — The  disease  is  incurable.  No  remedy 
seems  forthcoming  which  is  of  any  avail  against  it, 
though  the  coincident  debility  may  be  remedied. 
Still  patients  ma}'  be  made  comparativeh'  comfort- 
able by  bran  baths  and  free  oiling  of  the  surface. 
The  caking  maj'  be  got  rid  of  by  wet  compresses, 
alkaline  baths,  bathing  in  simple  baths,  or  rubbing 
in  grease  or  glycerine. 

Impetigo  is  a  pustular  eczema,  see  Eczema. 
There  is  a  special!}'  contagious  variety,  see  Conta- 
gious impetigo. 

Intertrigo,  see  Erytiiema. 

Itch,  see  Scabies. 

Keloid  is  a  hypertrophic  outgrowth  of  the  fibro- 
cellular  tissue  of  the  skin.  There  are  two  forms, 
the  idiopathic  and  the  traumatic,  the  latter  origi- 
nating in  an  excessive  growth  of  the  tissue  of  a 
Sf-ar  following  the  use  of  the  surgeon's  knife  or  the 
applications  of  acids  and  the  like.  In  the  idiopathic 
form,  a  firm,  prominent,  palish  colored  nodule  ap- 
pears on  the  skin  and  sends  out  processes,  as  it 
were,  from  its  periphery,  which  by  their  contraction 
pucker  in  the  skin  around  towards  the  central  mass. 
The  contractility  of  the  keloid  tissue  indeed  is  cha- 
racteristic. 

Treatment  consists  in  avoiding  all  irritation  of 
the  keloid  growths.     If  removetl  they  recur. 


TREATMENT    OF    SKIN    DISEASES.  57 

Kerion,  see  Tinea  kerioii. 

Lepra  is  an  old  term  for  psoriasis,  and  especi- 
ally that  form  which  consists  of  circular  rings  of 
disease. 

Iieucoderma  signifies  "white  skin,"  and  con- 
sists in  deficiency  of  pigment  in  a  part,  without  any 
structural  alteration  whatever.  It  is  a  disease  ob- 
served chiefly  in  those  who  have  resided  in  tropical 
climates,  and  it  is  probably  due  to  some  nerve  pare- 
sis. In  private  practice  it  is  usually  seen  affecting 
the  backs  of  the  hands,  the  neck,  and  adjacent 
parts,  or  the  genital  organs. 

It  oftien  imi^roves  greatly,  and  sometimes  disap- 
pears under  the  use  of  general  nervine  tonics  and 
galvanism  of  the  spine. 

Lichen  is  characterized  b}'^  the  presence  of  solid 
fleshy  papules  about  the  size  of  millet  seeds,  which 
preserve  their  characters  as  papules  throughout 
their  existence,  and  are  accompanied  by  marked 
itching.  Tlie  skin  generally,  moreover,  is  usually 
dr}^,  somewhat  thickened,  and  often  of  muddy  as- 
pect. The  eruption  may  appear  as  scattered  papules 
(L.  simplex)  attacking  one  or  more  regions,  or  even 
the  greater  part  of  the  trunk,  and  more  rarely  about 
the  extremities:  sometimes  as  groups  of  papules 
{L.circumscriptus).  Often  the  lichen  attacks  the 
backs  of  the  hands,  and  then  but  secondarily  may 
become  inflamed  and  give  out  a  discharge  {L.  agrius). 
It  is  in  this  situation  excited  by  the  contact  of  irri- 
tants, as  sugar  and  flour,  and  then  bears  the  name  of 


58  THE    DESCRIPTION    AND 

Grocers'  or  Bakers'  itch  (vide  these).  I  f  the  papules 
are  seated  at  the  hair  follicles,  giving  the  surface  a 
dotted,  or  even  on  a  small  scale  a  rasi)-like  appear- 
ance, the  name  L. pilaris  is  given.  So  called  L.  Hoi- 
dus  is  a  purpura;  that  is  to  sa}',  there  are  little 
haemorrhagic  papules  formed.  In  some  cases  solid 
red  papules  of  very  special  features  stud  various 
parts  of  the  surface  symmetrically,  and  especially 
at  the  front  of  the  forearms,  about  the  flanks,  the 
abdomen,  and  the  hips,  etc.  These  papules  attain 
the  size  of  a  large  pin's  head  or  more,  and  are  dull 
red,  angular  at  their  bases,  flat  at  top,  with  a  pecu- 
liar shiny  or  glazy  aspect,  and  umbilicated'more  or 
less  distinctly.  At  first  they  are  discrete,  but  they 
group  together  into  patches  by  the  springing  up  of 
new  papules  between  the  old.  Then  the  patch  be- 
comes red,  infiltrated,  and  slightly  scaly,  but  dis- 
tinctly papular  at  the  edge.  Dull  colored  stains  are 
left  on  the  disappearance  of  patches  or  papules.  The 
disease  is  accompanied  b}"^  a  severe  burning  sensa- 
tion or  itching,  and  patients  attacked  are  usually 
much  out  of  health.  It  is  known  as  L.  planut^. 
Tijere  is  3'et  a  further  condition  in  which  the  whole 
surface  of  the  body  is  generally  involved,  the  pajv 
ules  and  patches  occupying  whole  regions,  whilst 
there  is  also  marked  hyperemia,  itching,  rareh'  con- 
siderable marasmus,  nervous  irritability,  and  the 
like  symptoms.  This  severer  phase  is  rare  in  Eng- 
land ;  it  is  the  L.  ruber  of  Ilebra.  This  observer 
has  also  correctly  described  a  L.  scro/ulosorum, 


TREATMENT    OP    SKIN    DISEASES.  59 

which  occurs  in  those  who  exhibit  decided  signs  of 
scrofula.  The  eruption  is  made  up  of  groups  of 
little  pale  papules  the  size  of  millet  seeds,  each 
having  in  its  centre  a  little  exuvial  plug.  If  the 
disease  is  severe,  acneiform  pustules  may  develop, 
interspersed  with  the  papular  rash. 

Treatment. — Lichen  simplex  and  circumscriptus 
must  be  treated  as  simple  inflammations.  A  loaded 
system,  pyrexial  condition,  or  debility  should  be 
attacked,  but  alkalies  should  be  exhibited  in  some 
form  or  other.  Should  the  disease  not  speedily  dis- 
appear a  mild  mercurial  course,  or  one  of  Donovan's 
solution  may  be  given.  Locally  alkaline  and  gela- 
tine baths,  with  remedies  to  allay  irritation,  are 
needed,  as  (14),  (16),  (20),  (23),  (24),(30),(32S(37), 
(38),  (41  )i  In  L.  planus  the  indications,  as  regards 
internal  ti'catment,  are  to  improve  the  tone  of  the 
nervous  system  by  rest,  change  of  air,  and  general 
tonics,  including  arsenic,  but  especially  the  mineral 
acids  and  bitters;  to  alleviate  dyspeptic  troubles; 
to  feed  up  the  patient;  and  lastly,  to  attempt  to 
diminish,  hj'peraemia  by  astringents  such  as  per- 
chloride  of  iron.  As  regards  local  medication  it  is 
needful  to  allay  irritation  by  gelatine  and  alkaline 
baths  (la  and  16),  and  by  sedatives  (23  et  seq.);  to 
diminish  hyperemia  by  the  use  of  such  remedies  as 
(74),  (14) ;  and,  finally,  to  promote  the  absorption 
of  the  papules,  especially  by  vapor  baths,  and 
cautiousl}^  emplo3'ed  tarry  compounds. 

Lichen  urticatus,  see  Urticaria. 


60  THE    DESCRIPTION     AND 

Lupus  is  a  disease  characterized  by  the  forma- 
tion in  tlie  skin  of  a  neoplasm,  having  minnte  cha- 
racters like  those  of  granulation  tissue,  and  taking 
the  form  of  an  infiltration  or  of  tubercles.  This 
neoplasm  tends  to  invade  tlie  true  skin  texture  and 
undergo  degeneration,  thereby  leading  to  atrophy 
and  scarring.  Firstly,  the  neoplasm  may  take  a 
diffused  form,  and  L.  erythematodes  is  the  term  ai> 
plied  to  the  superficial  lupus  in  which  the  sebaceous 
glands  seem  to  be  specially  involved,  and  ap|)ear  as 
comedo-like  spots  studding  the  otherwise  reddened 
and  infiltrated  diseased  surface.  It  attacks  b^-  pre- 
ference the  cheeks  of  young  women  on  each  side  of 
the  nose,  the  two  lateral  patches  being  often  con- 
nected after  a  time  l»y  a  connecting  band  of  the 
disease,  stretching  laterally  over  the  nose  from  side 
to  side.  Similar  coexisting  patches,  leading  to 
atrophy,  are  observed  about  the  scalp,  fingers,  and 
rarely  other  parts  of  the  bod^-.  Secondly,  the 
neoplasm  may  form  distinct  tubercular  elevations, 
which  are  crowded  together  into  a  fleshy  mass  after 
awhile,  and  then  the  name  L.  Inhere uloaus^or  when 
it  does  not  ulcerate,  non-exedens,  is  given.  This 
form  attacks  the  face  and  nose  by  preference. 
Thirdly,  the  neoplasm  may  ulcerate  freely,  and 
then  the  disease  is  called  L.exedens.  This  attacks 
chiefly  the  nose  and  cheeks.  Lupus  tissue  or  tuber- 
cles are  soft  and  gelatinous-looking,  and  are  mark- 
edly vascular.  It  does  not  tend  so  much  to  break 
down  into  unhealthy  pus  as  to  undergo  fatty  de- 


TREATMENT    OF     SKIN     DISEASES.  Gl 

goneration,  and  in  this  respect  contrasts  with  syphi- 
litic tissue.  The  local  changes  in  lupus,  unlike 
S3'philis  again,  constitute  the  whole  of  the  disease. 

Treatment. — The  essential  point  is  to  destroy  the 
new  growth  b}'  caustics  repeatedly  applied,  but  not 
so  as  to  produce  unnecessary  cicatrization.  Great 
care  is  necessary  in  the  application  of  these  remedies, 
and  judgment  in  the  selection  of  appropriate  times 
and  cases.  Whenever  a  lupus  is  very  tender,  or 
shows  a  tendency  to  spread  rapidl}^,  or  becomes 
h3'perfemic  under  slight  causes,  caustics  should  not 
be  used  :  but  when  tlie  disease  is  indolent.  When 
the  lupus  is  red,  tender,  and  irritable,  it  is  useful  to 
exclude  the  air,  and  paint  once  or  twice  a  day  with 
liquor  plumbi  for  some  time.  The  caustics  most 
suitable  are  (5)  and  (9),  and  it  is  best  to  use  them 
to  the  edges  of  the  patches  in  tlie  first  instance,  and 
apply  a  poultice  if  there  is  much  pain.  The  caustic 
may  be  repeated  at  intervals  till  an  apparently 
healthy  surface  ap[)ears,  and  one  that  seems  inclined 
to  heal.  The  surface  should  then  be  dressed  with 
some  simple  astringent,  as  (74)  or  (35).  When 
lupus  patients  are  out  of  health,  they  should  take 
appropriate  tonics,  iron,  especially  cod-liver  oil,  and 
quinine.  The  slighter  forms  of  lupus  may  often  be 
cured  by  the  application  of  astringents  only. 

Maculae. — There   are   four   chief  forms — viz. : 

(1)  The  pigmentaiy,  occurring  idiopathically  as  in 

leucodernia  and  melanoderma,  or  symptomatically 

in  connection  with  uterine  excitation,  and  certain 

6 


62  TUE    DESCKIPTION     AND 

cachexire,  or  after  certain  eruptions ;  (2)  the  para- 
sitic, as  in  tinea  versicolor;  (3)  the  chemical,  due  to 
the  use  of  nitrate  of  silver;  (4j  the  liremorrhngic, 
as  in  purpura  {see  the  special  descriptions  of  the 
diseases  here  named). 

Medicinal  rashes. — Arsenic  is  said  to  excite 
herpes  zoster,  and  to  induce  hardness  and  indura- 
tion of  the  palms  of  the  hands ;  also  eczematous 
inflammation  and  ugly  ulceration  when  it  comes  in 
contact  with  the  skin  by  means  of  dyes,  as  in  flower- 
workers.  Iodide  of  potassium  induces  acne-like 
spots  and  buUaj  disseminated  over  the  surfa<-e. 
Bromide  of  potassium  excites  acne,  ecthyma,  and 
inflammation  of  the  sebaceous  glands  and  follicular 
walls,  with  retention  of  an  increased  formation  of 
sebum.  Tar  occasions  comedo  and  acne.  Copaiba 
a  terribly  pruritic,  raised,  uniform,  hyperaimic  rasli, 
followed  rarely  by  the  development  of  bulljB,  but 
more  frequently  by  wlieals.  Arnica  excites  eczema, 
and  sulphur  a  rash  like  an  abortive  non-discharging 
eczema. 

Miliaria  is  an  inflammation  of  the  sweat  follicles 
in  connection  with  disordered  sweat  function,  in  fact, 
sudamina  in  which  there  is  more  than  usual  hyper- 
aemia.  It  occurs  as  an  acute,  soft,  red,  pimply, 
scattered  general  rash,  in  pyrexial  states,  and  in 
hot  weather. 

Treatment — This  consists  in  the  adoption  of  a 
cool   regimen  and  the  exhibition  of   some  simple 


TREATMENT     OF     SKTN     DISEASES.  03 

diuretic,  with  the  use  of  a  weak  alkaline  or  oxide  of 
zinc  lotion,  as  (14)  or  (19). 

Molluscuin  contagiosum  is  a  disease  in  which 
the  sebaceous  glands  and  parts  around  are  enlarged 
and  distended  by  an  excessive  quantitj'  of  sebum, 
so  that  sessile,  pearly-looking,  round,  little  tumors 
are  produced,  which  have  the  peculiarity  of  an  um- 
bilication  in  the  centre,  disclosing  the  distended 
opening  of  the  gland  duct.  They  vary  in  size  from 
a  pin's  point  to  a  split  pea.  A  white  cheesy  matter 
may  be  squeezed  out  from  the  opening,  and  the  sac 
thus  more  or  less  emptied.  The  face  is  the  chief 
seat  of  the  disease,  and  it  occurs  mainly  in  children. 
It  is  apparentl}^  semi-epidemic  at  times,  and  ajDpears 
too  to  be  contagious. 

Treatment — When  small,  the  tumors  may  be 
touched  with  acid  nitrate  of  mercury' ;  when  large, 
the  contents  should  be  emptied,  and  the  interior  of 
the  emptied  sac  touched  with  a  point  of  nitrate  of 
silver. 

Morphcea  is  characterized  by  tlie  formation  in 
the  skin  of  white,  bacony-like,  slightly  elevated  in- 
durations, that  feel  firm  and  look  polished,  opaque, 
and  dense,  and  are  surrounded  by  a  lilac-colored  ring 
of  vessels,  more  or  less  distinctly  marked.  The  dis- 
ease is  a  fibroid  degeneration,  and  may  consist  of  a 
small  patch  the  size  of  a  threepenny  piece,  or  of  one 
or  more  larger  ones.  The  disease  may  lead  to  atro- 
phy of  the  skin  texture,  or  a  resolution  may  take 
place  without  any  ill  effect  being  left  behind.     It  is 


64  TDK    D  E  8  C  R  I  r  T  I  O  N    AND 

seen  chiefly  on  the  trunk,  limbs,  and  face;  in  the 
latter  situation  some  little  deformity  may  result. 
Sometimes  it  is  conjoined  to  scleroderma.  It  attacks 
particularly  weak  females.  It  runs  a  very  indolent 
course,  indeed,  and  as  regards  duration,  it  tends  to 
disaijpear  after  a  lengthened  course  of  tonics.  Tlie 
disease  should  not  be  locally  irritated,  and  local 
applications  do  no  good. 

Nails  are  subject  to  a  variety  of  diseased  condi- 
tions. The  clubbing  and  striation,  as  an  effect  of 
exhausting  disease  such  as  phthisis,  are  well  known. 
They  are  ill-formed,  and  rendered  opaque  and  brit- 
tle, and  it  may  be  thickened  in  psoriasis,  pityriasis 
rubra,  lichen  planus,  and  sometimes  in  ichthyosis. 
They  are  likewise  stunted,  and  more  or  less  atro- 
phied in  some  cases  of  sj-philis,  and  idiopathically 
in  those  who  are  weak  and  out  of  health.  The  nail- 
bedj  or  matrix,  often  gets  inflamed  with  pain,  heat, 
swelling,  and  suppuration,  occasioning  perhaps  tlie 
loss  of  tlie  nail.  This  is  called  onychia,  and  it  may 
be  syphilitic,  strumous,  or  erysipelatous  in  origin. 
Lastly,  the  nails  may  be  thickened  and  rendered 
brittle,  and  raised  from  their  bed  by  the  attack  of 
fungi,  and  then  the  disease  is  known  as  onychomy- 
cosin. 

A  few  words  may  be  added  as  regards  the  diag- 
nosis of  these  several  conditions.  lu  jjsoriasis 
of  the  nails  all  or  most  of  the  nails,  of  the  hands, 
and  perhaps  the  feet,  are  affected.  They  become 
at  flrst  speckled,  then  opaque,  uneven,  dull,  and 


TREATMENT    OF    SKIN    DISEASES.  65 

brittle,  and  the  free  edge  splits  up  into  several 
layers.  The  clue  to  the  nature  of  the  disease  is 
often  given  by  the  existence  of  psoriasis  about  the 
body,  and  one  method  of  treatment  for  the  nail 
and  surface  disease  may  be  followed  out.  Onycho- 
mycosis mostl}^  occurs  together  Avith  some  form  of 
tinea  of  the  head  or  body.  It  may  arise  by  a  tinea 
circinata  travelling  from  the  finger  to  the  nail,  or 
the  nail  alone  may  be  affected  in  those  who  have 
been  attending  to  ringworm  cases.  No  psoriasis 
c;in  be  found,  moreover,  on  the  body  in  these  cases. 
The  nail  becomes  opaque  and  brittle  about  the  base 
and  sides ;  then  it  thickens,  is  loosened  away  from 
its  bed,  and  breaks  up  into  layers.  Generally  in 
onycliomycosis — and  this  is  a  very  important  point 
— only  one  nail  is  affected,  and  more  rarely  two, 
and  only  exceptiomdly  more  than  that.  The  nails 
of  the  feet  are  healthy,  or,  in  other  words,  onycho- 
mycosis only  attacks  the  nails  of  the  hand.  When 
scrapings  of  the  nail  are  examined,  fungus  elements 
will  he  detected.  The  treatment  consists  in  soak- 
ing the  nail  in  a  sulphurous  acid  lotion  (one  part  to 
three  or  four  of  water)  constantly,  and  applying 
acetic  acid  every  or  every  other  ([ay,  but  short  of 
producing  irritation.  Syphilitic  disease  of  the 
nails  may  consist  in  general  atrophy  or  indolent 
inflammation.  In  the  latter  condition  the  parts  at 
the  base  of  the  nail  become  painful,  swollen,  and 
red ;  suppuration  follows,  and  unhealthy  ulcera- 
tion with  loosening,  and  perhaps  loss  of  the  nail. 
6* 


66  THE    DESCRIPTION    AND 

Several  fingers  may  be  affected  at  one  time.  The 
diagnosis  is  rendered  clear  by  the  concomitance  of 
other  evidences  of  syphilis  in  the  individual.  T!ie 
treatment  consists  in  the  application  of  black  wasli 
externally  and  anti-syphilitic  remedies  internally. 
Onychia^  when  simple,  is  known  b}'  its  acute  onset 
and  course,  and  the  entire  absence  of  syphilitic  or 
strumous  symptoms.  The  treatment  is  that  of  a 
sharp  local  inflammation  ;  nitrate  of  lead  ointment 
is  highly  recommended  for  the  disease. 

Pediculi,  see  Phthiriasis. 

Pemphigus  is  known  by  the  occurrence  of  oval 
bladders  of  bullae,  varying  in  size  from  a  split  pea 
to  a  pigeon's  egg.  Each  bulla  contains  at  first, 
and  is  distended  by,  a  semi-transparent  fluid  ;  soon, 
however,  the  fluid  gets  opaque,  and  the  bulla 
becomes  flaccid  and  dries  up,  leaving  a  slight  scab, 
or  giving  rise  to  a  superficially  excoriated  surface. 
The  disease  may  be  acute  and  pretty  general,  as  in 
those  returned  from  the  tropics,  or  in  unhealth}' 
ciiildren.  If  it  occurs  in  the  newl^-  born  and  about 
tlie  hands  and  feet,  it  is  probably  s^'philitic  and  one 
of  a  series  of  syphilitic  phenomena.  Chronic  pem- 
phigus may  consist  of  one  bulla  (P.  solilarius),  or 
of  mau}^  in  successive  crops,  and  it  lasts  an  indefi- 
nite time.  A  form  called  F.  foliaceua  attacks  the 
bod}'  generally,  beginning  in  one  spot,  and  gradu- 
ally invading  the  bodj'.  The  bullae  are  more  or 
less  abortive,  and  give  rise  to  flaky  incrustations 
covering  the  surface  of  the  body,  and  presenting 


TREATMENT    OF    SKIN    DISEASES.  67 

the  aspect  of  a  crusted  eczema,  only  that  bullce  are 
detected.  It  is  a  rai'e  form  of  the  disease,  and 
occurs  in  the  debilitated.  Sometimes  a  prurigi- 
nous  rash  is  found  intermingled  with  the  bullfe  in 
pemphigus;  and  to  this  condition  the  term  P.pru- 
riginoHus  has  been  applied. 

Treatment. — It  is  held  that  the  remedy  for  pem- 
phigus is  arsenic.  Quinine,  in  large  doses,  is  useful. 
Cachectic  conditions  should  be  carefully  attended  to, 
especial!}'  in  old  people.  Locally,  soothing  applica- 
tions alone  can  be  used. 

Phthiriasis,  formerly  called  pinirigo  senilis^  is 
caused  by  tlie  attack  of  the  pedicnlus  vestiraenti. 
The  disease  consists  in  the  presence  of  certain 
peculiar  hemorrhagic  specks,  and  the  phenomena 
of  secondary  irritation  induced  by  the  pediculi  and 
scratching.  It  occurs  chieflj^  in  the  aged,  but  it 
also  is  met  with  amongst  younger  persons  who  are 
uncleanly.  The  pediculi  attack  the  regions  of  the 
clavicles  and  neck  first  of  all;  and  it  is  there  the 
first  evidences  of  the  disease  must  be  traced.  The 
haemorrhagic  marks  ai'e  not  raised  like  scratched 
follicles,  nor  irregular  like  excoriations,  but  round, 
with  a  central  depression,  at  the  bottom  of  which  is 
dried  blood.  The  pedicnlus  inserts  the  proboscis 
into  a  pore,  which  it  distends,  and  as  the  proboscis 
is  withdrawn  tlie  blood  wells  up  to  fill  the  follicle. 
Tlie  irritation  and  scratching  induce  the  develop- 
ment of  papules,  whose  apices,  when  scratched  off, 
become  covered  by  scales  of  dried  blood  (prurigi- 


68  THE     DESCRIPTION     AND 

nous,  as  it  is  called).  This  condition,  together  with 
ncth3malons  pustules, excoriations  from  scratching, 
wheals,  etc.,  constitute  the  secondary  eruption  of 
phthiriasis.  At  first  the  mischief  is  localized  to  the 
neck  and  shoulders,  but  presently  it  spreads  over 
the  back,  abdomen,  buttocks,  etc. 

Treatment. — It  consists  in  giving  warm  baths, 
smearing  the  skin  with  some  parasiticide,  as  (114), 
(115),  (124),  to  keep  away  the  i)ediculi,  and  in  care- 
fully baking  the  clothes  worn  by  the  patients  at  a 
temperature  of  220°  F. 

Pityriasis  consists  in  an  excessive  shedding  of 
epithelial  scales  in  the  form  of  brawny  desquamation. 
It  may  be  the  result  of  local  irritation  or  of  mal- 
nutrition. Pityriasis  versicolor  is  a  form  of  ring- 
worm, and  it  is  described  under  Tinea.  One  variety 
of  pityriasis,  P.  rubra,  is  a  ver^'  severe  disease.  It 
begins  on  one  part  of  the  body  as  a  red  scaly  spot, 
and  rapidly  spreads,  so  as  to  involve  the  whole  sur- 
face in  a  very  short  space  of  time.  1'he  bod}-  is 
intensely  red,  and  covered  by  lamellar  imbricated 
scales,  that  are  freely  exfoliated  from  day  to  day. 
The  face  is  flushed  and  the  scalp  even  desquamates. 
It  is  said  to  be  incurable,  but  this  is  certainly  not 
the  case. 

Trealmeyil. — The  slighter  forms  are  relieved  by 
internal  tonics  and  the  inunction  of  oil  or  some 
slight  astringent.  P.  rubra  must  be  treated  as  a 
disease  consisting  in  general  hjperiemia  of  the  skin 
due  to  nerve  paresis.     The  patient  must  be  wrapped 


TREATMENT     OF     SKIN     DISEASES.  ()  9 

in  oil,  and  quinine  and  cod-liver  oil  must  be  given 
after  the  free  exhibition  of  diuretics,  to  relieve  the 
hyperjemic  skin.  Finall^^,  perchloride  of  iron  will 
be  found  verj'  useful  as  convalescence  approaches. 

Porrigo,  a  term  now  obsolete,  but  formerly  ap- 
plied indiscriminately  to  any  crusted  eruption  or 
scaly  incrustation,  especially  about  the  face  or  head. 
It  included  favus,  ringworm,  eczema,  etc 

Prickly  Heat,  or  Lichen  Tropicus,  occurs  in 
the  tropics  mostly,  but  in  a  milder  form  in  this 
countr}^,  and  in  the  summer.  It  is  seen  as  a  minute, 
red,  very  itch}",  pimply  rash,  due  to, inflamed  sweat 
follicles.  It  studs  the  surface  of  the  body,  the  limbs, 
and  often  the  face,  and  is  interspersed  with  sudamina 
here  and  there.  The  itching  is  increased  bj^  heat, 
hot  liquids,  etc. 

Treatment Exhibit  diuretics  freely :  avoid  all 

stimulants:  wear  light  clothing:  take  light  food: 
use  alkaline  baths :  and  smear  the  surface  with 
whiting  made  into  a  thin  paste. 

Prurigo  must  not  be  confounded  with  Phthiriasis. 
It  is  a  rare  disease,  and  is  characterized  by  the 
development  of  small,  hard,  pale  or  flesh-colored 
I)a pules,  which  in  their  early  stage  are  better  felt 
than  seen,  accompanied  by  intolerable  itching. 
The  papular  rash  is  primary  in  prurigo,  and  not  a 
secondary  condition,  as  in  phtliiriasis  ;  nor  is  it  in 
any  wa}'  caused  by  pediculi.  The  papules  are  due 
to  chronic  inflammatory  changes  in  the  papillary 
layer  of  the  derma,  and  sometimes  the  deeper  stratum 


70  THBDESCEIPTIONAND 

of  the  skin.  They  occur  mostly  on  the  lower  limbs, 
buttocks,  lower  part  of  the  abdomen,  and  outer  part 
of  the  forearms.  The  disease  is  termed  P.  vhlis  if 
the  papules  are  small  or  limited  in  extent,  or  the 
itching,  and  disease  generally,  not  severe.  When 
the  disease  is  well  marked,  the  papules  crowd  to- 
getiier  in  certain  situations  in  patches,  especially  on 
the  legs :  they  are  felt  under  the  skin  before  being 
clearly  discernible  to  the  eye,  and  the  itching  or 
disordered  sensation  termed  formication.,  is  like 
creeping  of  ants.  To  this  condition  the  term  P. 
formicans  is  given.  In  certain  cases  where  the  dis- 
ease is  extensive,  and  more  or  less  congenital  and 
persistent,  it  is  called  P.  agria  or  ferox.  Eczema 
here  supervenes  or  more  or  less  suppuration  occurs, 
with  glandular  enlargements  in  the  groin,  whilst 
the  skin  feels  thickened  and  indurated  in  the  chronic 
stage.  In  England  the  severer  form  is  not  common. 
The  writers  have  only  met  with  few  cases,  and  the 
disease  of  milder  type  has  occurred  in  their  experi- 
ence in  those  exposed  to  alternate  heat  and  cold 
in  their  occupation,  and  who  have  become  debili- 
tated. 

Treatment. — This  should  consist  in  improving  the 
general  health,  in  given  arsenic  (90  el  seq.),  or  ( 100), 
in  the  employment  of  vapor  and  alkaline  baths, 
and  the  use  of  sedatives,  chiefly  (23),  (30  \  (34), 
(69),  (71),  (74),  as  they  may  best  suit. 

Pruritus,  or  itching,  is  an  accompaniment  of 
most  skin  diseases,  especially  eczema,  lichen,  pru- 


TREATMENT    OF     SKIN     DISEASES.         71 

rigo,  urticaria,  scabies,  and  pbthiriasis.  But  it  may 
arise  in  the  skin  without  any  eruption,  and  then  it 
is  usually  dne  to  the  circulation  of  some  acidity,  as 
bile  products,  urea,  uric  acid,  etc.;  or  to  some  dis- 
order of  the  nerves  ;  or  it  is  excited  by  some  local 
irritant,  as,  for  instance,  about  the  rectum  by  asca- 
rides,  about  the  head  and  pubis  by  pediculi,  about 
the  body  by  flannel,  friction,  or  scratching.  It 
must  be  remembered  that  the  appearance  of  the 
skin  is  always  altered  by  scratching,  as  it  causes 
follicles  and  papillae  to  become  hj-periemic  and  pro- 
minent; their  apices  get  scratched  off,  and  a  drop 
of  blood  exudes  and  dries  as  a  speck.  This  pruritic 
rash  is  most  erroneousl}'  termed  prurigo  (which  see). 
In  old  people  pruritus  (senilis)  occurs  as  an  hyper- 
jEsthesia,  and  consequent  on  the  general  atrophy  of 
the  skin  ;  but  in  such  persons  the  causes  mentioned 
above  come  readily  into  play. 

The  following  hints  relative  to  the  more  common 
causes  of  itching  may  be  found  useful.  Itching 
increased  at  night  by  the  Avarmth  of  the  bed,  with  a 
pimple  rash  about  the  front  of  the  arms  and  the 
body,  is  suspicious  of  scabies.  Itching  in  old  peo- 
ple about  the  shoulders  and  back,  of  pbthiriasis. 
At  the  back  of  the  head  In  children,  of  pediculi  in 
the  head.  Itching,  with  eruption  about  the  fork  of 
the  thigh,  of  parasitic  disease  and  intertrigo  (ex., 
eczema  marginatum).  Itching  of  capricious  charac- 
ter, suddenl}-  coming  and  going  here  and  there,  es- 
pecially at  night,  and  without  visible  eruption  in  the 


72  THE     DESCRIPTION     AND 

da3time,  is  suspicious  of  urticaria.  In  the  wintertime 
esi>eeially  it  is  not  uncommon  for  the  skin  in  certain 
persons  to  be  irritable,  particularly  towards  even- 
ing, or  when  the  clothes  are  taken  off",  and  tlie  air 
obtains  access  to  the  skin.  The  itching  in  such 
cases  has  been  termed  pj'iwitus  hiemaiis,  or  winter 
pruritus.  It  occurs  in  various  parts  of  the  body, 
but  more  especiall}^  about  the  thighs  and  legs.  In 
some  cases  no  eruption  can  be  seen,  but  in  others 
there  is  decided  turgescence  and  prominence  of  the 
hair  follicles,  enougli  in  degree  perhaps  to  consti- 
tute lichen  pilaris.  The  disease  is  supposed  to  be 
"  neurotic,"  but  it  is  probably  due  to  inactivity  of 
the  perspiratory  function  m  the  majority  of  cases: 
at  the  same  time  there  is  frequently  defective  excre- 
tion of  nitrogenous  matters  and  bile  products.  It 
is  not  exclusively  a  winter  affection,  though  most 
common  at  tliat  time  because  of  the  inactivity  of 
the  skin.  Scratching,  it  must  be  remembered,  maj' 
excite  lichen,  eczema,  ecthyma,  and  the  like,  whereby 
the  primary  disorder  may  be  masked. 

Treatment. — A  number  of  remedies  for  itching 
occurring  in  connection  with  particular  diseases  will 
be  found  in  formulae  (18)  to  (44),  and  scattered  else- 
where. Starch,  borax,  or  alkaline  baths  should  be 
administered  when  the  skin  is  hyperremic  or  irritable, 
and  in  the  early  stages  of  pruritic  mischief.  In  the 
indolent  aspect,  or  later  stages,  snlphuret  of  potas- 
sium or  mineral  acid  baths  are  of  decided  eflicaey. 
As  regards  internal  treatment,  this  varies  with  the 


TREATMENT     OF     SKIN     DISEASES.  73 

case.  Itcliiiig  due  to  the  circulation  of  retained  ex- 
creta may  be  relieved  by  appropriate  aperient  and. 
alkaline  remedies,  Avhilst  nervine  tonics  will  be  suit- 
able for  the  "  neurotic"  itching.  All  parasites  and 
other  local  irritants  must  be  destroyed  or  removed 
(i^ee  209  el  seq.),  and  flannel  especially  should  not 
be  allowed  in  contact  with  the  skin  in  severe  [>ru- 
ritis.  Further  information  will  be  gathered  from 
the  special  descriptions  of  the  several  diseases  men- 
tioned here  with  which  itching  is  associated. 

Psoriasis  is  a  disease  characterized  by  h\'per- 
trophous  growth  of  the  epithelial  layers  of  the 
skin  leading  to  a  heaping  together  of  whitish 
silvery  looking  masses  of  scales,  which  on  T)eing 
removed  disclose  a  hypernemic  cutis  with  papilht, 
enlarged  b}^  engorgement  of  the  vessels.  The  chief 
seats  of  tiie  disease  are  the  elbows,  knees,  and  head, 
but  also  the  bod 3^  and  limbs  generally.  The  disease 
is  often  hereditary.  It  begins  by  the  development 
of  small  spots,  P. punctata:  these  gradually  enlarge 
and  look  like  drops  of  mortar,  hence  the  terra  P. 
guttata.  Soon  many  acquire  the  size  of  a  sixpence 
or  shilling  and  are  generally  round,  and  now  the 
name  P.  nummularis  or  circinata  is  given.  In 
some  cases  large  patches  are  formed  by  the  coales- 
cence of  the  spots,  so  that  a  great  extent  of  surface 
is  covered ;  this  is  called  P.  vulgaris.  Should 
patches  take  on  a  serpentine  form,  the  term  P. 
gyrata  is  used,  and  if  the  affection  is  ver^'^  chronic 
P.  inmterala.  Lastly,  if  the  crusting  is  freer  than 
7 


T4  THE    DESCRIPTION    AND 

nsnal  and  assumes  a  conical  shape,  the  name  P. 
rupioides  is  applied,  the  epithelial  elements  being 
in  this  case  mixed  with  pus ;  it  is  dependent  on  a 
strumous  habit.  A  common  local  phase  is  P.  pal- 
maris,  likely  to  be  confounded  with  syphilitic  dis- 
ease; hut  the  formei'  is  generally  a  part  of  a  more 
general  affection,  and  it  does  not  begin  nor  is  it 
limited  to  the  palm  of  the  hand,  as  is  the  syphilitic 
disease  as  the  rule. 

Treatment. — In  children  cod-liver  oil,  quinine, 
iron,  and  arsenic  shouhl  be  given  if  the  scales  are 
very  plentiful  and  silvery,  see  (90),  (92),  (106),  (.107), 
properly  proportioned  in  dose  to  the  age  of  the 
patient.  Locally  alkaline  baths  may  be  used  with 
the  inunction  of  oil  as  long  as  the  h3'pera}mia  lasts, 
and  afterwards  some  mild  tar  application  as  (70). 
In  adults,  gouty  conditions  must  be  rectified.  If 
the  skin  be  ver^-  hypertemic  diuretics  should  be 
exhibited,  and  the  skin  simply  soothed  b}'  alkaline 
baths  and  oil  inunction.  Then  arsenic  may  be  given 
freely,  (90  et  seq.)  and  (106  ^/  seq.).  Locally  at  first 
mild  mercurial  ointment,  (62),  (63),  and  lastly 
tarry  preparations,  (68),  (69),  (70),  (71),  may  be 
used.  In  no  disease  is  more  care  needed  to  unravel 
the  exact  coml)ination  of  conditions  conducing  to 
the  disease.      {See  Ecmarks,  Part  L,  p.  29.) 

Purpura  is  characterized  by  minute  extravasa- 
tions of  blood,  at  first  bright  red  and  afterwards 
indigo  color.  The  size  varies  from  pin  points  to 
large  specks  and  blotches,  and  these  even  run  into 


TREATMENT    OF    SKIN     DISEASES.         15 

patches  scattered  over  the  surface,  especially  on  the 
legs.  Slight  pyrexia  accompanies  it,  and  the  eruj)- 
tion  cannot  be  effaced  by  pressure.  This  is  P.  sim- 
plex. A  more  severe  form  in  which  haemorrhage 
takes  place  more  freely  into  the  skin,  and  from  the 
mucous  surfaces,  is  known  as  F.  hsemorrhagica. 

Treatment. — The  latter  condition  requires  very 
great  care.  The  former :  rest,  acids,  quinine,  per- 
chloride  of  iron,  turpentine  (100),  gallic  acid,  etc. 

RingAVorm,  see  Tinea. 

Rodent  ulcer  is  the  least  malignant  form  of 
cancer.  It  I'arel}-  occurs  before  the  age  of  fifty,  and 
begins  as  a  solitarj-,  indolent  tubercle  somewhere  in 
the  upper  two-thirds  of  the  face.  This  tubercle 
after  two  or  three  or  several  years  cracks  and  shows 
a  tendency  to  ulcerate,  the  ulcer  when  formed  being 
bounded  by  hard  sir.uous  edges  which  are  not  under- 
mined ;  the  surface  is  cleanish  and  no  glands  become 
implicated,  nor  is  there  any  cachexia.  The  disease 
makes  very  slow  progress  and  is  paiidess. 

Treatment. — Free  excision  at  the  earliest  possible 
moment  with  or  without  the  subsequent  use  of  caus- 
tics. If  removed  effectually  the  disease  does  not 
return.     For  caustics,  see  (3),  (4),  and  (5). 

Roseola  is  a  hypeiaemia  of  a  rosy  hue,  either 
symptomatic,  and  then  part  only  of  certain  acute 
febrile  disease, as  rheumatism,  vaccinia, cholera,  etc. . 
or  idiopathic,  as  seen  mostly  in  children  during 
change  of  season  {R.  infantilis),  and  in  connec- 
tion with  slight  stomach  derangement.     It  may  be 


76  THE    DB80RIPTI0N    AND 

genernl  and  resemble  measles,  but  there  are  no  true 
catarrhal  symptoms;  the  rash  is  not  crescentic  in 
character,  and  is  more  rosy  than  that  of  measles. 
Though  it  may  be  distributed  more  or  less  wholly 
over  the  body,  still  it  is  decidedly  patch^Mn  charac- 
ter. It  may  occur  in  rosy  circles  and  rings  {R. 
annxdata)^  esijecially  about  the  limbs,  and  in  the 
autumn  or  summer  (J?.  mUumnalis  and  R.  sestiva). 

Treatment. — In  tlie  idiopathic  forms  salines  and 
laxatives  should  be  exhibited  and  some  simple  oint- 
ment used. 

Rupia. — In  this  eruption  small  flattish  bulla?  are 
developed,  with  at  first  clearish  contents,  quickly 
Incoming  like  a  mixture  of  blood  and  pus.  The 
bullae  dry  into  dark  thick  scabs  hiding  unhealthy 
ulceration.  The  crusts  increase  by  additional  dis- 
charge which  "  dries  on"  as  it  were  from  below  as 
the  ulceration  increases.  They  are  consequently^ 
conical,  stratified,  dark  and  adherent,  and  the 
"cockle-shaped"  crusts  are  in  fact  diagnostic  of 
rupia.  Should  they  be  moderate  in  size  the  disease 
is  termed  R.  simplex,  if  large  and  prominent,  R. 
prominens ;  if  the  ulceration  is  excessive  and  pha- 
gedenic, R.  escharolica.  The  disease  is  always 
Hyphililic. 

Treatment. — This  should  be  as  for  tertiary  sy- 
philis {see  84  et  svq.).  The  ulcers  may  be  cleaned 
b}'  iotlide  of  starch  and  dressed  with  black-wash  or 
(Gl),  (81),  (82),  (83). 


TREA1MENT    OF    SKIN    DISEASES.  77 

Scabies  or  Itch  is  caused  bj  the  burrowing  in 
the  skin  of  an  insect  called  the  acarus  scabiei.  This 
burrowing  excites  much  itching  and  some  h3'perae- 
raic  rash ;  the  patient  scratches  for  relief,  and  so 
occasions  much  of  the  rash  that  is  seen  in  scabies. 
Hence  scabies  consists  of  an  eruption  due  to  the 
presence  of  acari  in  their  burrows,  together  with  a 
secondar}'  rash,  the  results  of  the  irritation  of  the 
skin.  The  appearance  presented  l)}^  the  acarus  in 
its  burrow,  which  is  characteristic  of  scabies,  is  as 
follows:  Where  tiie  acarus  enters,  a  vesicle  forms, 
and  the  animal's  course  is  traced  by  a  slightly  raised 
straight  or  tortuous  line  (cuyiiculus)  from  one  to 
many  lines  in  length,  at  the  end  of  which  the  pre- 
sence of  the  imbedded  intruder  is  marked  as  an 
opaque  spot  generall}-.  The  furrow  or  cuniculus 
becomes  discolored  by  dirt,  and  then  has  a  dark 
tint  with  darker  dots  along  its  course,  probably  the 
excreta  of  the  acarus.  Now  these  furrows  are 
mostly  seen  in  the  adult  in  the  interdigits  and  about 
tlie  wrists  in  the  earl 3'  stage  of  the  disease,  but  sub- 
sequently about  the  penis  at  its  upper  line  and  other 
parts  of  the  front  of  the  bod^'.  In  children  tiie 
buttocks  and  feet  may  alone  be  the  seat  of  scabies. 
Of  course  the  furrows  lose  their  characteristic  ap- 
pearance after  a  good  scratching,  as  they  are  torn 
open  and  the  acarus  frequently  dislodged.  If  pa- 
tients are  cachectic  both  the  vesicle  and  the  furrow 
may  suppurate,  as  in  so-called  pustular  scabies. 
The  "secondary  rash"  consists  of  hypersemic  folli- 
7* 


78  THE    DESCRIPTION     AND 

cles  and  papillae  forming  papules,  of  ecthymatous 
pustules  excited  by  scratching,  and  sometimes  of 
eczema  and  urticaria.  The  results  of  irritation  are 
seen  in  early  scabies  in  the  adult  on  the  front  of  the 
forearms  and  about  the  wrists ;  in  chronic  scabies 
on  the  front  of  the  belly  and  on  the  upper  part  in 
front  and  inner  surface  of  the  thighs ;  in  children 
about  the  lower  limbs,  buttocks,  and  abdomen. 
Scabies  is  accompanied  by  marked  itching,  which 
is  always  worse  at  night,  and  several  members  of 
a  family  are  often  the  subjects  of  attack  at  the  same 
time.  Cuniculi  are  absolutely  diagnostic,  but  if 
these  cannot  be  detected,  itching  at  night  in  persons 
who  have  a  pimply  rash  in  the  intenligits  or  fore- 
arms or  npper  line  of  the  penis  is  very  suspicious, 
and  much  more  so  if  several  persons  in  the  same 
family  ai*e  affected  similarly  together. 

Scabies  in  Private  Practice. — It  is  impor- 
tant to  remark  that  scabies  often  differs  very  much 
in  aspect,  according  as  it  occurs  in  hospital  or  in 
private  practice.  Amongst  the  poor,  and  especially 
the  uncleanly,  the  burrowings  of  the  acari  in  the 
skin  are  attended  with  the  formation  of  papules, 
vesicles,  pustules,  wheals,  etc.,  in  abundance.  IJut 
amongst  the  well-to-do,  and  particularly  those  who 
observe  great  cleanliness,  the  ordinary  results  of 
the  irritation  produced  by  the  acari  may  be  almost, 
if  not  entirely,  absent.  So  that  if  a  student  were 
to  be  guided  by  the  ordinary  descriptions  given  in 
books  of  scabies,  he  would  certainly  not  be  able  to 


TREATMENT    OF    SKIN    DISEASES.  79 

diagnose  the  scabies  present.  The  disease  would 
not  answer  in  description  to  papular,  pustular,  or 
A^esieular  scabies,  and  yet  true  scabies  might  be 
present.  We  have  seen  several  cases  lately  in 
which  patients  complained  of  itching  intensified  at 
night  in  different  parts  of  the  body,  and  in  whose 
skin  nothing  could  be  detected  but  a  few  cuniculi 
about  the  hands  or  the  penis,  and  an  apology  for 
a  vesicle  here  and  there.  We  have  seen  a  multi- 
tude of  acarian  furrows  about  the  hands  and  other 
parts  in  a  case  of  scabies,  and  nothing  else.  In 
other  cases  we  have  observed  just  a  few  very  fine, 
delicate,  pale,  flesh-colored  papules,  the  result  of 
irritation  set  up  by  acari  present  in  the  skin,  and 
nothing  more,  and  these,  which  were  lichenous 
papules,  were  difficult  to  make  out.  In  all  cases 
in  which  a  patient  complains  of  itching  aggravated 
at  night,  even  though  there  be  none  of  tlie  ordinary 
evidences  of  scabies  present,  yet  a  diligent  and 
active  search  for  cuniculi  should  be  made  about 
the  hands  and  penis.  We  have  known  patients 
treated  with  powerful  internal  remedies  for  "  pru- 
rigo," lichen,  and  the  like  for  weeks,  whilst  scabies, 
which  existed,  was  wholly  unsuspected  because 
there  were  no  papules  and  pustules  present.  Pa- 
pules, pustules,  and  vesicles  are  indeed  accidental 
accompaniments  of  scabies,  which  should  be  looked 
upon  as  consisting  essentially  of  the  acari  in  their 
furrows  (cuniculi) — i.e.,  the  real  scabies,  and  the 
phenomena  of   irritation  (papules,  pustules,  etc.) 


80  THE     DESCRIPTION    AND 

snperatUletl,  wliicli,  under  certain  circumstances, 
ma}^  by  entirely  absent.  Two  or  three  cases  of 
scabies  limited  to  the  penis  have  recentl}-  come 
under  our  notice.  In  all  of  the  cases  careful  search 
detected  cuniculi.  In  two,  suppurating  buboes 
were  produced  by  the  irritation,  and  the  disease 
was  thought  to  be  syphilitic.  The  diagnosis  was 
rendered  easy  by  the  absence  of  any  decided  indu- 
ration about  the  scabies  spots,  their  vesico-pustular 
origin,  pruritis  intensified  at  night,  the  presence  of 
cuniculi,  and  the  absence  of  any  concomitant  evi- 
dence of  syphilis. 

Ti'eatment — The  majority  of  cases  are  cured  by 
a  free  inunction  night  and  morning  of  (114)  or  (120) 
for  three  nights  and  mornings.  The  patient  must 
thoroughly  wash  himself,  and  if  free  from  itching 
on  the  fourth  night  may  be  regarded  as  well.  It  is 
important  not  to  overdo  the  sulphur  inunction,  but 
cease  it  after  a  day  or  two,  for  it  often  sets  up  in 
itself  irritation,  and  the  continuance  or  increase  of 
itching  is  taken  for  an  aggravation  of  the  disease. 
After  three  days'  treatment  the  remedy  may  be 
lightl}'  applied  to  any  solitary  vesicles  that  make 
their  appearance.  If  any  jjarts  feel  hot  and  tender 
(74)  should  be  used  to  soothe.  In  chronic  scabies 
it  may  be  necessary  to  make  freer  and  more  potent 
applications  (110  et  seq.).  Often  the  free  use  of 
storax  ointment  will  be  found  most  effectual ;  and 
so  also  ointments  of  iodide  of  potassium  and  car- 
bolic acid. 


TREATMENT    OF    SKIN     DISEASES.  HI 

Scleroderma  is  a  disease  duo  to  hypertrophons 
growth  of  the  fibro-ceHnlar  tissue  with  infiltration 
by  coagulable  fluid.  In  consequence  the  sliin  be- 
comes first  of  all  stiff,  then  hard,  and  then  indurated 
like  leather,  and  it  cannot  be  pinched  up  or  wrinkled. 
The  disease  is,  as  a  rule,  one  of  adult  Ufe;  it  may 
come  on  after  exposure,  perhaps  suddenly  and  may 
aflfect  one  or  more  regions,  or  more  or  less  of  the 
body.  It  frequently  attacks  the  nape  of  the  neck, 
or  the  front  of  the  chest,  or  a  limb.  The  hardness 
and  induration,  which  is  raised  and  yellowish  look- 
ing, may  take  the  form  of  bands,  or  occur  continu- 
ously over  an  extensive  area.  The  stiffness  pro- 
duced may  interfere  with  respiration  or  the  move- 
ments of  the  face  or  joints.  In  some  cases  it  occurs 
in  conjunction  with  morphea,  or  the  edge  of  the 
sclerodermic  band  may  present  the  aspect  of  mor- 
phoea. 

Treatment. — The  disease  may  gradually  diminish 
under  general  tonics  internally,  and  friction  with 
oil  externally,  but  treatment,  as  a  rule,  is  not  found 
to  be  very  influential  in  curing  this  disorder. 

Scrofuloderma. — This  disease  commences  as 
indolent,  painless,  livid  tubercles  that  gradually 
soften  up  and  give  place  to  foul,  ragged,  unhealthy 
ulcers  with  pallid  granulations,  free  secretion,  and 
may  be  crusting.  Occasionally  the  ulceration  is 
superficial  and  creeps  along  the  surface.  The  scro- 
fulous features  will  be  recognized  in  this  disease 


82  THE    DB80RIPT10N     AND 

in  the  family'  history,  ph^'siognom}',  physical  condi- 
tion, glandular  complications,  etc.,  in  the  patient. 

Treatment  consists  in  administering  cod-liver  oil, 
iron,  quinine,  and  good  food  internally,  and  locally 
in  the  application  of  iodide  of  starch  to  cleanse  the 
foul  sores,  and  then  some  mild  astringent ;  whilst, 
in  the  later  stages,  soap  and  mercurial  plaster  is 
used  with  iodine  fumigation. 

Seborrhcea. — This  consists  in  an  excessive 
secretion  of  sebum.  It  may  be  more  or  less  oily, 
and  give  rise  to  a  greasy  skin  (S.  oleoaa):  or  it  may 
dry  into  fatty  plates,  consisting  of  dirty  white  flat 
scales  that  feel  greasy,  and  are  easily  detached,  ex- 
posing a  very  slightly  reddened  and  non-excorlated 
skin  in  which  the  sebaceous  glands  are  more  distinct 
than  usual.  This  is  the  common  form  of  seborrhaja, 
and  constitutes  what  is  termed  "dandriff"  or 
"  scurf"  in  the  head.  Thirdly,  the  fatty  secretion 
may  take  the  form  of  little  plugs  distending  the 
orifices  of  the  glands,  and  then  the  skin  feels  harsh 
like  a  file  (5.  cornea).  The  seats  of  seborrha-a  are 
especially  the  scalp  and  the  face.  It  is  liable  to  be 
confounded  with  eczema,  but  in  seborrhrjea,  although 
the  skin  is  reddened,  there  is  no  breach  of  surface 
as  is  seen  when  the  scaliness  and  crusting  are  re- 
moved. The  follicles  are  seen  also  to  be  more  patent 
than  usual,  and  the  incrustation  is  also  soft  and 
greasy,  and  not  the  result  of  the  drying  of  "  dis- 
charge." 

Treatment. — It  is  requisite  to  give    tonics  and 


TREATMENT    OP    SKIN    DISEASES.  83 

arsenic,  as  (90\  (93),  (94),  (108) :  locally  to  get  off 
the  crusts  by  oil}'  inunction,  and  to  apply  astrin- 
gents, as  (11),  (14),  (25),  (40),  (51),  (73). 

Strophulus  or  Red  Gum. — Tliis  term  has  been 
applied  to  many  different  eruptions,  consisting  of 
soft  red  papules  in  infants ;  in  one  case,  to  li3'per- 
remic  papillte,  in  another  to  hypersemic  sweat  glands, 
and  again  to  distended  sebaceous  glands.  So-called 
strophulus,  characterized  by  bright-red  points, 
seated  on  the  face  and  arms  of  children,  is,  in  fact, 
a  hyperemia  of  the  papillae  or  sweat  glands,  mostly 
induced  b^'  the  child  being  kept  very  much  wrapped 
up,  and  so  overheated.  S.  albidus  is  the  terra  given 
to  the  small  pearl 3'-white  specks  seen  about  the  face 
of  children,  and  due  to  distended  sebaceous  glands. 
The  hyperamic  states  alluded  to  above  are  exagge- 
rated by  any  stomach  disturbance. 

Treatment. — Some  mild  aperient  and  ant-acid 
should  be  given,  with  the  adoption  of  a  cool  regi- 
men, and  the  local  use  of  some  simple  soothing 
lotion,  as  (74). 

Sudamina  is  the  term  applied  to  the  little 
vesicles  formed  by  distension  of  the  upper  laj'er  of 
the  cuticle  by  sweat.  They  are  apt  to  occur  about 
the  clavicles,  neck,  or  face,  but  often  may  be  seen  in 
other  parts,  whenever  the  skin  is  stimulated  to  ac- 
tivity during  the  establishment  of  convalescence 
from  pj-rexial  attacks,  or  from  keeping  the  body 
too  warm.  They  are  especially  frequently  seen 
in  acute  rheumatism.      No  treatment  is  required, 


84  THE    DESORIPTION    AND 

as  the  vesicles  rapidly  disappear  of  their  own 
accord. 

Sycosis  signifies  inflammation  of  the  hair 
follicles  of  the  beard  and  whiskers.  It  may  be 
caused  by  a  vegetable  parasite,  and  then  possesses 
special  features  (see  Tinea  sycosis),  or  it  may  arise 
as  an  idiopathic  inflammation  of  the  follicles,  and 
then  is  called  simply  ftycosis.  In  this  latter  form 
the  disease  consists  in  the  development  of  pustules, 
pierced  by  a  hair,  scattered  here  and  there  about 
the  hairy  parts  of  the  face.  The  pustules,  whicli 
indicate  that  the  whole  hair  sacs  are  inflamed,  may 
become  more  or  less  indurated  at  their  bases,  form- 
ing qnasi-tubercles.  If  the  inflammation  is  severe, 
and  the  pustules  are  crowded  together,  tliere  may 
he  considerable  discharge  and  crusting  :  the  derma 
and  connective  tissue  textures  of  the  affected  part 
being  involved,  so  that  the  parts  are  i-eddened,  hot, 
swollen,  and  infiltrated,  and  the  i)atient  may  suffer 
great  pain.  Tlie  disease,  however,  differs  very 
much  in  severitj'.  It  often  occurs  in  the  debilitated, 
the  intemix^rate,  the  dyspeptic,  and  eczeraatous.  It 
often,  too,  runs  a  very  chronic  course,  especially  in 
strumous  subjects,  and  in  such  cases  more  or  less 
atrophy  and  loss  of  hair  may  result. 

Treatment. — It  is  generall}^  considered  that  epila- 
tion rapidly  cures  the  disease,  but  this  is  a  mistake, 
and,  indeed,  the  procedure  often  does  harm.  It 
does  good  if  there  is  much  chronic  inflammatory 
thickening  involving  the  deep  parts  of  the  follicle 


TREATMENT    OP    SKIN     DISEASES.  85 

with  suppuration,  and  should  be  followed  by  the 
use  of  a  weak  white  precipitate  ointment.  The  dis- 
ease should  be  treated  as  a  simple  inflammation, 
locally  b}'  hot  fomentations  and  soothing  remedies 
in  the  early  and  acute  stages ;  subsequently  by 
the  use  of  astringents,  as  (75),  followed  by  weak 
mercurial  ointments ;  and  lastly,  tar  or  sulphur 
applications.  .  Internal  treatment  consists  in  the 
use  of  aperient  tonics,  as  (95),  cod-liver  oil  and  iron 
when  needed,  and  lastly,  a  course  of  Donovan's  so- 
lution where  there  is  much  indolent  thickening. 
Where  there  is  much  thickening,  painting  with 
liquor  potassae,  followed  up  with  the  use  of  mercu- 
rial plaster,  is  often  of  service,  but  the  disease  must 
be  indolent  for  this  treatment. 

Syphilis  of  the  Skin  is  met  with  in  connection 
with  hereditary  and  acquired  s^-philis. 

Hereditary  syphilis  is  practically  nearl3'  synony- 
mous with  congenital  or  infantile  syphilis.  This 
form  is  uncommon  before  the  end  of  the  second  or 
beginning  of  the  third  week,  and  it  is  rare  after  the 
sixth  month ;  the  usual  period  of  its  occurrence  is 
when  the  child  is  about  three  weeks  or  a  month  old. 
No  one  can  mistake  the  tainted  infant ;  the  general 
aspect  is  more  or  less  marasmic  ;  the  child  presents 
a  shrivelled,  "  old  raan"-like  aspect ;  the  skin  is 
dirty  and  muddy,  has  lost  its  elasticity,  and  hangs 
in  loose  folds  ;  it  is  dry,  often  exfoliating,  and  more 
or  less  erythematous  about  the  buttocks.  The  cry 
of  the  child  is  harsh  and  cracked  (characteristic), 
8 


86  THE    DESCIIIPTION     AND 

and  "the  snuffles,  produced  by  inflammation  and 
ulceration  of  the  nasal  mucous  membrane,  are  pre- 
sent." The  disease  is  further  characterized  by  the 
presence  of  mucous  tubercles  about  the  anus  or 
mouth  ;  fissures  at  the  angles  of  the  mouth  ;  ulcera- 
tion of  mucous  surface ;  a  high  arched  palate ;  in- 
flammation of  the  thymus  gland  ;  various  eruptions 
over  the  bod}',  especially  about  the  feet  and  hands, 
in  the  form  of  erythemata  or  bulUe;  a  subacute 
onychia  is  possibly  present;  and  these,  together 
with  a  family  historj'  of  syphilis,  are  diagnostic. 

With  regard,  however,  to  the  eruption,  it  is  gene- 
rally in  the  form  of  a  dull-red  erythema  of  the 
hands,  feet,  and  perianal  region,  with  or  without 
tubercular  formations  ;  but  it  may  in  cachectic  sub- 
jects consist  in  ugly  ulcerations  arising  out  of  tuber- 
cles, bullae,  or  pustules. 

The  treatment  consists  in  gently  mercurializing 
the  child  by  the  use  of  gray  powder  or  mercurial 
inunction  (a  small  portion  of  blue  ointment  being 
rubbed  into  the  soles  of  the  feet  each  night),  in 
keeping  up  the  nutrition  of  the  body  by  good  food, 
by  giving  cod-liver  oil  and  chlorate  of  jwtash,  and, 
if  the  child  is  nursed,  in  giving  the  nurse  a  course 
of  iodide  of  potassium. 

Acquired  syphilis. — When  in  the  adult  an  erup- 
tion is  due  to  this  cause,  there  is  usually  imparted 
to  it  a  coppery  tint,  and  a  more  or  less  circular  form  ; 
the  general  distribution  of  the  eruption  is  notice- 
able, and  generally  there  is  absence  of  pain  and 


TREATMENT    OF     SKFN     DISEASES.  81 

itching;  there  is  a  polymorphism  about  it — i.e., 
papules,  tubercles,  and  ulcers  (occasioning  loss  of 
substance),  etc.,  occur  together ;  cachexia,  ulcerated 
throat  or  tongue,  alopecia,  nocturnal  pains  in  dif- 
ferent parts  are  often  concomitants  ;  and  a  histor3' 
of  the  primary  disease  may  be  connected  by  different 
links  with  the  present  condition  by  a  series  of  sy- 
philitic occurrences. 

Syphilodermata  may  be  divided  for  all  practical 
purposes  into  three  groups;  (a)  those  that  are 
hypeneniic ;  {h)  those  that  have  deposit  (or  new 
tissue  formation)  as  the  main  feature;  and  (c) 
degenerative  lesions,  the  result  of  suppuration  and 
ulceration  of  the  syphilitic  new  tissue  formed  in  the 
skin. 

The  following  sketch  may  throw  light  on  this 
subject.  The  first  etfoct  of  the  syphilitic  poison 
upon  the  general  system  is  to  give  rise  to  syphilitic 
fever  and  transitory  hyper<iemic  lesions,  as  roseola 
and  erythema.  Sufficient  time  having  elapsed  for 
the  action  of  the  poison  upon  the  nutrition  of  the 
textures,  a  second  period  ensues,  in  which  modifi- 
cations of  their  normal  growth  take  place — that  is, 
new  tissue  is  formed  (granulation  or  S3q)hilitic 
tissue),  and  the  results  appear  in  the  form  of 
papular,  tubercular,  squamous,  and  pustular  erup- 
tions, mucous  tubercles,  gummata,  etc.  But  mean- 
while the  circulating  poison  has  caused  the  skin 
glands  to  inflame  {syj)hilitic  acne),  and  the  follicles 
{syphilitic  lichen).     These  commence  also  in  h}-- 


88  THE    DESCRIPTION    AND 

perjEmia  of  the  sebaceous  glands  and  follicles,  hut 
now  not  of  a  trausient  character,  but  followed  up 
by  infiltration  of  granular  tissue  into  and  about  the 
parts.  The  nerve-trunks  also  may  become  irritated 
by  the  poisoned  blood,  or  the  deposit  about  tliem, 
and  herpes  and  pemphigus  occur  as  a  consequence. 
A  common  occurrence  is  80-<'alled  syphilitic  palmar 
psoriasis,  which  consists  in  a  hard,  indurated, 
cracked,  scaly  surface,  or  hard  tubercles  about  the 
palm  of  the  hand,  and  in  connection  with  other 
signs  of  S3philis.  Tlie  further  stage  of  syphilis  of 
the 'skin  consists  in  the  infiltration  by  the  syphi- 
litic granulation  tissue  of  the  deeper  parts,  and 
more  extensively  than  before  of  the  superficial 
ones,  whilst  the  patient's  general  healtii  becomes 
cachectic.  Tlien,  in  this  third  stage  tlie  syphilitic 
tissue  softens  up,  suppurates,  or  ulcerates ;  and 
this  latter  si  age  is  characterized  by  degenerative 
clianges  in  the  sj'philitiu  deposit  in  ditferent  parts, 
as  is  seen  in  ulcers,  on^'chia^  etc. 

Treatment. — Internally  in  the  papular,  tulier- 
cular,  squamous,  and  pustular  syphilides,  mercurial 
treatment  is  called  for,  and  the  bicjanide  pill  (105) 
is  the  l)est  form,  and  tlie  pill  may  be  given  for 
three  or  four  weeks,  or  omitted  before  the  gums 
begin  to  be  affected.  See  also  (84  et  seq.)  and  (104). 
Iodide  of  potassium  may  be  given  at  the  same  time 
in  increasing  doses.  In  the  ulcerating  forms,  if  the 
patient  be  well  nourished  and  pretty  strong,  there 
is  no  objection  to  a  mercurial  course;  but  where 


TREATMENT    OP    SKIN     DISEASES..         89 

cachexia  is  marked,  and  the  patient's  condition  is 
one  of  evident  debility,  iodide  of  potassium,  with 
cod-liver  oil,  or  iodide  of  iron  and  good  food,  con- 
stitute the  best  treatment.  In  cachectic,  subjects, 
who  are  debilitated,  restless,  and  irritable,  opium 
given  internally  is  of  much  service.  In  reference 
to  iodide  of  potassium,  it  must  be  borne  in  mind 
that  its  use  is  beneficial  in  direct  proportion  to  the 
duration  of  the  disease ;  hence  when  nodes,  tuber- 
cles, caries,  and  secondary  ulcers  are  present,  or 
when  mercury  has  been  fully  used  or  apparently 
failed,  the  dose  should  be  gradually  increased  by 
three  or  four  grains  every  few  days,  until  in  the 
case  of  old-standing  and  ulcerating  syphilis  it 
reaches  thirtj'  or  forty  grains.  In  most  cases  the 
exhibition  of  the  decoction  of  various  woods  is 
advisable  ;  the  compound  decoctions  of  sarza  and 
guaiacum  are  the  best;  they  keep  the  skin  and 
bowels  acting  freely,  and  thus  very  materially  help 
the  elimination  of  the  poison. 

When  a  patient  Is  under  the  influence  of  mercuiy 
he  should  avoid  stimulants,  cold,  and  other  sources 
of  irritation  and  catarrh;  the  indulgence  in  stimu- 
lants, indeed,  is  a  source  of  infinite  harm,  and  a 
common  cause  of  aggravation  of  syphilis  of  the 
skin.  The  diet  should  be  good  and  nutritious,  and 
the  administration  of  mercury  should  always  be 
followed  up  by  a  course  of  mineral  acids  and 
bitters,  or  iron  and  quinine,  etc.;  or  tonics  may  be 
8* 


90  THE    DESCRIPTION    AND 

given  simultaneously  with  the  specific  remed}', 
and  with  a  liberal  hand  if  the  general  health  is  bad. 

Mercurial  fumigation,  which  acts  both  locally 
and  generally,  is  in  great  favor  with  some  practi- 
tioners. If  the  skin  eruption  is  extensive  it  may 
be  employed  twice  or  more  a  week. 

Locall}',  the  erythematous  forms  require  no 
special  application,  but  a  lotion  of  oxide  of  zinc  and 
calamine  may  be  used.  Should  they  be  obstinate 
and  leave  behind  auj'  papules,  a  white  precipitate 
ointment  may  be  used.  The  squamous  and  papular 
eruptions  are  relieved  b}'  calomel  ointment,  biclilo- 
ride  lotion,  and  nitric  oxide  of  mercury  ointments. 
The  tubercular  and  ulcerating  forms  are  those 
which  require  special  local  medication;  in  the 
former,  the  weak  nitrate,  or  nitric  oxide  of  mercury 
ointments,  are  those  more  especiallj'  useful,  and 
nitrate  of  mercury  may  be  cautiously  used  to  de- 
stroy obstinate  indurations ;  ulcers  may  be  dressed, 
if  painful,  with  a  solution  of  watery  extract  of 
opium,  or  be  dusted  over  with  calomel,  or  be  stimu- 
lated with  the  nitric  oxide  of  mercury  oiutment, 
dilute  nitric  acid,  and  borax  lotions  (45),  (02),  ((53), 
or  treated  by  the  local  application  of  mercurial 
vapor.  Should  ulcers  be  very  foul  and  dirty-look- 
ing iodide  of  starch  (52)  is  a  good  remecl  y,  and  when 
cleansed  the  sore  may  be  dressed  b}'  a  weak  mercu- 
rial application  or  astringent  wash.  Formulae  (3), 
(7),  (23),  (58),  (59),  (GO),  (Gl),  (80),  (81),  (82), 
(83),  may  be  referred  to. 


TREATMENT    OP     SKIN    DISEASES.  91 

Tinea  is  the  generic  term  given  to  the  vegetable 
parasitic  diseases,  which  are  here  enumerated  :  — 

1.  Tinea  favosa  or  favus,  caused  by  a  fungus 
called  achorion  Schonleinii. 

2.  Tinea  tonsurans,  or  ordinary  "ringworm"  of 
the  scalp,  caused  by  the  trichophyton  tonsu7'ans. 

3.  Tinea  kerion  is  a  modification  of  the  last,  and 
is  caused  by  the  same  parasite. 

4.  Tinea  circinafa,  or  ordinary  ringworm  of  the 
body,  includes  Burmese  ringworm,  Malabar  itch, 
Chinese  ringworm,  etc,  and  is  caused  by  the  tricho- 
phyton tonsurans  also. 

5.  Tinea  sycosis  or  mentagra,  or  sycosis  parasi- 
tica, is  caused  by  the  microsporon  mentagrai^hytes. 

6.  Tinea  versicolor,  or  Chloasma,  or  Pityriasis 
versicolor,  is  caused  by  the  microsporon  furfur. 

7.  Tinea  decalvans,  or  area,  or  alopecia  (one 
form),  is  caused  by  the  microsporon  Audouini. 

There  are  two  other  parasitic  diseases  which  may 
be  mentioned  here — viz..  Mycetoma,  or  the  madura 
foot  or  fungus  foot  of  India,  caused  by  the  chionyphe 
Carteri;  and  Onychomycosis,  or  onychia  parasitica, 
alluded  to  at  p.  64. 

Tinea  favoso  is  rare  in  England.  It  attacks  the 
young,  and  is  known  by  the  presence  of  dry,  light, 
sulphur-colored,  cup-sliaped,  umbilicated  crusts, 
made  up  of  fungus  elements,  and  pierced  in  tiie 
centre  by  a  hair  from  the  underlying  follicle. 
These  crusts  may  run  together  into  a  confused  mass 
in  some  cases. 


92  TUE    DESCRIPTION     AND 

Treatment. — The  point  is,  after  getting  off  all  the 
crusts  by  oil  soakage,  to  destroy  the  parasite  by 
Bulphiirous  acid  lotion,  and  then  epilate  bit  by  bit 
of  the  surface,  and  apply  such  parasiticides  as  121, 
122,  134,  136,  until  the  microscope  shows  that  the 
hair  is  free  from  fungus. 

Tinea  tonsurans  is  very  common,  but  almost 
unknown  in  the  adult.  It  is  sometimes  epidemic 
in  schools,  spreading  from  child  to  child  by  con- 
tagion. The  typical  disease  consists  of  circular 
patches,  varying  from  a  sixpence  to  a  five-shilling 
piece  in  size  or  larger,  having  a  slightly  raised  and 
scurfy  surface,  the  hairs  on  which  are  dry,  brittle, 
lustreless,  and  broken  off  close  to  the  scalp.  This 
condition  is  caused  by  the  fungus  attacking  the 
hairs — a  fact  easily  shown  by  soaking  a  diseased 
hair  in  weak  potash  solution,  and  then  examining 
it  under  the  microscope ;  it  will  be  seen  that  the 
hair  is  invaded  to  a  greater  or  less  degree  by  the 
conidia  of  the  trichoph3'ton  tonsurans.  These 
conidia,  when  very  numerous,  besides  crowding 
around  the  hair  shaft,  collect  into  parcels  within, 
and  separate  the  fibres  of  the  shaft  one  from  another, 
so  that  the  hair  is  split  \\\).  These  short,  broken-ofT, 
opaque,  dull  hairs  are  diagnostic.  Tiixea  tonsurans 
and  tinea  circinata  are  often  observed  in  the  same 
subject,  and,  in  fact,  they  are  essentially  the  same, 
only  that  one  occurs  on  hairy,  the  other  on  non- 
hairy  parts. 

Treatment. — If  the  fungus  has  not  got  deeply 


TREATMENT    OP    SKIN     DISEASES.  93 

into  the  follicle,  it  can  readily  be  destroyed  :  there- 
fore the  more  recent  the  disease  the  more  easily 
can  it  be  cured.  In  very  recent  cases,  two  or  three 
applications  of  the  tincture  of  iodine  of  double 
strength,  or  a  blistering,  may  almost  if  not  quite 
cure  ;  this  should  be  followed  by  the  use  for  awhile 
of  some  mild  parasiticide,  as  (121)  or  (122).  The 
hair  should  be  cut  off  the  scalp  for  an  inch  or  so 
around  and  about  the  diseased  patches. 

In  chronic  cases,  if  there  are  many  patches  scat- 
tered over  the  head,  the  wiiole  hair  should  be 
shaved  or  cut  off  close  to  the  scalp ;  and,  if  much 
diseased,  the  whole  head  may  be  soaked  in  sulphur- 
ous acid  lotion  (125,  one  part  to  three  or  four  of 
water)  for  a  week,  to  get  rid  of  the  disease  on  the 
mere  surface.  Then  it  is  well  to  epilate  over  a  cer- 
tain area  day  by  day,  subsequently  appljnng  (130) 
cautiously  for  seven  or  eight  or  more  ai)plications 
at  intervals  of  three  or  four  days.  The  application 
will  form  a  cake,  and  this  should  be  removed  by 
grease  or  soap  in  a  day  or  two,  or  when  it  begins  to 
"  flake  off,"  and  before  a  fresh  application  is  made. 
Blistering  may  be  used  instead.  In  getting  off 
the  caking,  a  number  of  diseased  hairs  come  away 
entangled  in  the  flakes,  and  this  may  serve  in  place 
of  a  repetition  of  epilation.  It  is  no  use  applying 
(136)  to  the  surface  whilst  the  cake  is  on  it,  but  a 
clear  surface  must  be  obtained  about  three  days  or 
so  after  an  application.  It  is  advisable  to  continue 
the  applications  until  the  hair  begins  to  grow  out  in 


04  THE    DESCRIPTION     AND 

a  natural  direction  and  manner,  and  then  to  apply 
some  mild  parasiticide,  as  (128)  or  (134).  In  severe 
cases,  epilation  must  be  carried  out  again  and  again 
over  tiie  patches,  and  parasiticides  must  not  be  dis- 
continued as  long  as  a  single  broken-off  hair  can  be 
detected,  or  any  little  dark  stubs  are  visible,  or  until 
the  hair  grows  evenly  and  well  over  the  surface. 
The  parasiticides  that  are  used  are  ver}'  multitudi- 
nous; a  few  suggestions  will  be  found  in  the  Cuta- 
neous Pharmacopoeia. 

Tinea  circinala^  or  ringworm  of  the  bod^-,  is 
characterized  by  the  occurrence  of  patches  wiiich 
are  red,  scaly,  and  itchy,  circular  in  form,  and  with 
a  well-defined  edge.  It  begins  as  a  little  red  scurfy 
spot  which  gradually  enlarges,  and  when  it  has 
reached  a  fair  size  the  skin  in  the  central  part  moy 
be  apparently  healthy;  usually  the  edge  looks  red 
and  scaly,  the  centre  generally  somewhat  paler  and 
less  seal}",  though  covered  with  a  brannj'  defrquaraa- 
tion.  The  edge  of  the  patch  may  be  vesicular,  and 
the  disease  is  evidently  inflammatory',  though  ex- 
cited by  a  fungus  that  spreads  equally  in  all  direc- 
tions, and  so  produces  the  circular  form.  The 
inflammation  falls  short  of  that  which  occurs  in 
eczema.  Any  scurfy,  red,  itch}'  patch  then  on  the 
surface  of  the  body  should  always  be  examined  for 
fungus  elements.  The  fungus  is  the  same  that  occa- 
sions tinea  tonsurans,  and  the  two  diseases  often 
occur  together. 

In  hot  climates  especially,  the  fungus  sometimes 


TREATMENT    OP    SKIN    DISEASES.  95 

luxuriates  upon  the  skin,  particularly  in  the  myce- 
lial form,  and  hence  tinea  circinata  occurs  in  very 
large  patches,  that  are  very  hyperremic  at  their  ex- 
tending, well-defined  edge,  but  with  desquamating 
and  slightly  seal}'  centres.  In  the  fork  of  the  thigli 
and  contiguous  parts,  patches  that  have  tlie  charac- 
ters of  tinea  circinata  in  an  exaggerated  form  occur, 
and  are  characterized  particularly  by  the  festooning 
downwards  over  the  thigh  from  the  groin  of  a  red, 
scah',  itchy  patch,  that  has  a  well-defined  circular, 
and  papular  edge.  This  is  the  Burmese  or  Chinese 
ringworm. 

Treatment. — This  is  always  successful.  The  con- 
stant use  of  some  such  parasiticide  as  (122),  (128), 
or  simple  tincture  of  iodine,  or  an  ointment  made 
of  five  grains  of  white  precipitate  and  ten  to  twentj' 
of  carbolic  acid,  will  always  cure  the  disease. 

Tinea   sycosis In  this  disease,  which  is  very 

rare  in  England,  unlike  non-parasitic  sycosis  (see 
Sycosis),  the  hairs  are  loosened,  rendered  brittle, 
and,  in  fact,  changed  as  in  tinea  tonsurans,  and  the 
disease  is  to  be  treated  in  a  similar  manner. 

Tinea  versicolor  (Pityriasis  versicolor  or  Chlo- 
asma).— This  disease  consists  of  fawn-colored 
patches  occurring  in  the  parts  covered  by  flannel, 
especially  the  front  of  the  chest  and  the  root  of  the 
neck.  The  patches  vary  in  size,  and  may  dot  over 
the  surface  or  run  together  so  as  to  cover  uniformly 
a  large  area.  They  are  raised  and  itchy,  and  scales 
can  be  scraped  from  them,  which  under  the  micro- 


96  THE    DESCRIPTION    AND 

scope  are  seen  to  be  invaded  by  conidia  (in  heaps) 
and  the  mycelial  threads  (very  wav})  of  the  fungus 
— the  mivroiiporon  furfur.  The  disease  is  some- 
times mistaken  for  8\'philitic  maculae,  but  the  latter 
are  not  raised,  not  itchy,  and  not  scurfy. 

Treatment Apply  (127)  regularly'  and  for  about 

ten  days  or  so  after  all  appearance  of  the  disease 
has  vanished. 

Tinea  kerion  is  simply  tinea  tonsurans  in  which 
the  hair  follicles  are  a  good  deal  inflamed  and  pour 
out  an  albuminous  fluid.  The  special  features  of 
the  disease  are — the  general  prominence  of  the 
patch ;  its  perforation  with  foramina — id  est,  the 
swollen  mouths  of  the  hair  follicles;  the  outpouring 
of  a  mucous  fluid ;  the  non-suppuration  of  the 
swelling,  which,  although  feeling  boggy  and  as 
about  to  suppurate,  should  never  be  opened ;  and 
the  looseness  of  the  hairs.  The  disease  leaves 
temporary  bald  patches  behind,  and  the  fungus  is 
observed  to  have  invaded  the  hairs,  as  in  tinea 
tonsurans. 

Treatment. — Allay  the  inflammation;  cpilate; 
and  then  use  some  very  mild  parasiticide,  as  in 
ordinary  ringworm. 

Tinea  decalvans,  see  Alopecia. 

Urticaria,  or  Nettlerash. — The  features  that 
attract  attention  as  altogether  dingnostic  of  tliis 
affection  are — firstly,  the  sudden  wa}'  in  which  the 
erythematous  rash  ai)pears  and  disappears,  or,  in 
other  words,  the  capriciousness  of  the  eruption  ; 


TREATMENT  OP  SKIN  DISEASES.    9*7 

secondly,  the  development  of  "wheals,"  like  those 
caused  by  the  stings  of  nettles,  in  the  centre  of  the 
red  h3-per8emic  patches.  It  has  differences  as  it 
occurs  in  the  adult  and  child. 

In  the  adult  the  wheals  are  alwaj^s  well  marked, 
and  leave  no  trace  of  their  presence  behind  when 
they  disappear.  The  urticaria  may  be  acute,  gene- 
rally the  result  of  some  dietetic  error — for  instance, 
the  eating  of  shell-fish  or  some  unwholesome  irri- 
tating food,  as  potted  meats,  and  there  is  pyrexia 
often  of  a  severe  character,  with  even  vomiting  and 
prostration.  The  skin  itches  dreadfull}^,  and  then 
out  comes  the  wheal  eruption.  Sometimes  the  face 
is  attacked  and  swells  enormously,  but  the  erup- 
tion at  once  discloses  the  nature  of  the  case. 

In  the  child  the  wheals  are  not  so  distinct,  and 
are  followed  by  the  development  of  little  fleshy 
papules — hence  the  term  lichen  urticatus.  These 
papules  become  "  pruriginous"  in  proportion  as  the 
disease  is  chronic. 

In  both  children  and  adults  the  disease  may  be 
primary  mx^  idiopathic,  or  secondary  io  some  other 
disease,  as  scabies  and  phthiriasis.  In  the  latter 
there  will  be  a  history  of  antecedent  disease  of  the 
kind  mentioned,  and  the  actual  concomitants  of  the 
symptoms  of  these  diseases.  In  the  idiopathic  form 
tlie  hyperaemia  and  wheals  exist  as  the  sole  disease 
present. 

Treatment. — In  the  adult  in  the  acute  form  an 
'  emetic  may  be  given  if  need  be,  with  alkalies,  and 
9 


98  THE    DESCRIPTION    AND 

a  slight  aperient.  Chronic  urticaria  in  the  ad  nit  is 
much  more  troublesome.  There  is  no  i\vrexia,  but 
constant  recurrence  of  redness  and  wiieals  with 
heat  and  itching.  Assuming  the  existence  of  an 
irritable  state  of  skin,  the  eruption  appears  to  be 
kept  up  by  dyspepsia  and  uterine  or  liver  disorder. 
Large  doses  of  alkalies  internally,  followed  by  (95), 
and,  if  desirable,  arsenic,  with  bran  and  alkaline 
baths  (la  and  16),  or  vapor  baths  if  the  skin  does 
not  act  properly,  are  beneficial.  Such  lotions  as 
(18),  (23),  (26),  (27),  (30),  (31),  (33),  and  many  like 
ones  may  be  used.  A  similar  line  of  treatment 
must  be  adopted  for  the  child  in  the  early  stages, 
though  care  should  be  taken  to  keep  the  kidneys 
acting  well,  and  to  give  cod-liver  oil  if  the  heallh 
is  poor.  Locall^^,  soothing  remedies  are  needed  (74) ; 
but  sulphuret  of  potassium  baths  in  chronic  cases 
are  very  efficacious.  Ointments  of  storax  or  calomel 
and  belladonna  will  be  foimd  successful  in  allaying 
accompanying  pruritus,  especially  if  excited  by 
animal  parasites,  such  as  bugs,  fleas,  lice,  etc. 

Vitiligoidea. — This  is  the  term  applied  to  the 
buff-colored  patches  that  form,  especially  at  the  inner 
canthus  of  the  eye,  in  those  who  have  suffered  fiom 
chronic  liver  disorder  and  have  had  jaundice.  It 
occurs  also  about  the  general  surface  of  the  body 
as  yellow  or  buff  nodules.  The  treatment  required 
is  that  for  hepatic  disease. 

Xanthelasma  is  the  term  given  by  Mr.  Wilson 
to  Vitiligoidea. 


TREATMENT    OF    SKIN     DISEASES.         99 

Xanthelasmoidea  is  a  term  given  to  certain 
biifF-colored  patches  that  appear  in  a  scattered  form 
in  3"oung  children,  resembling  Xanthelasma.  It  is, 
however,  very  rare,  and  has  no  connection  with 
jaundice. 

Xeroderma,  see  Ichthyosis. 

Zoster,  see  Herpes. 


PART    III. 

CUTANEOUS  PHARMACOrCEIA. 


BATHS. 

1.  The  quantity  of  water  in  a  bath  is  estimated 
ftt  thirty  gallo7is,  and  the  temperature  of  the  water 
should  be  from  90°  to  95°  F. 

(a;)  Bran  and  gelatine  bath. — The  quantities  to 
be  used  are — of  bran,  2  to  6  lb  ;  o^ gelatine,  1  to  3 
ife ;  or  of  size,  2  to  4  tb.  Used  in  all  erythematous 
and  itchy  and  scaly  diseases. 

(6.)  An  alkaline  bath  is  made  with  from  5ij  to  ^x 
of  bicarbonate  of  soda,  or  3iij  of  borax.  It  is  some- 
times useful  to  add  to  the  bicarbonate  of  soda  some 
bran  liquor  made  by  infusing  bran  in  hot  water. 
Used  in  eczema,  psoriasis,  urticaria,  lichen,  and 
prurigo,  where  there  is  much  local  irritation. 

(c.)  An  acid  bath  is  made  with  5j  of  nitric  or 
muriatic  acid  or  a  mixture  of  the  two  (sj  of  each). 
Used  in  chronic  lichen  and  prurigo. 

{d.)  Sulphurated  potash  bath  has  .fij  to  ^iv  to 
each  bath.  The  compound  sulphur  bath  of  Startin 
has  sij  of  sulphur  (prrecii>.),  .^j  of  hyposulphite  of 
soda,  and  5ss  of  dilute  sulphuric  acid  with  a  pint  of 


CAUSTICS.  101 

water.      Used  in  itch^  chronic  eczema^  lichen^  and 
psoriasis. 

FUMIGATION. 

2.  To  administer  a  medicinal  vapor  bath,  heat  is 
to  be  applied  simultaneously  to  the  drug  and  a 
small  tray  of  water,  so  that  steam  and  the  vapor 
of  the  drug  may  arise  and  surround  the  patient's 
body  together.  The  necessary  apparatus  may  be 
obtained  at  any  instrument-maker's  or  easily  be  im- 
provised. A  quarter  of  an  hour  should  usually 
suffice  for  the  proper  action  of  the  bath. 

For  a  mercurial  bath  fifteen  to  thirty  grains  of 
calomel,  and  for  a  sulphur  bath  from  one  to  two 
ounces  of  sulphur  should  be  used. 

CAUSTICS. 

3.  Calomel,  lijss;  bisulphide  of  mercury,  9 ij  ; 
arsenious  acid,  5j.  Used  in  lupus  ^scrofulous  ulcers, 
and  syphilis. — Dupuytren. 

4.  Caustic  potash  and  water  in  equal  parts.  Use- 
ful in  lupus. 

5.  Acid  nitrate  of  mercury,  made  by  dissolving 
§j  of  mercury  in  |j  of  nitric  acid  (sp.  gr.  1.40). 
Used  in  neoplasniata,  etc. 

6.  Chromic  acid,  5j  ;  water,  5iv.  Used  for  warts, 
lupus,  etc. 

7.  Powdered  savin;  perchloride  of  mercury;  red 
oxide  of  mercury,  aa  5j.  Used  for  condylomata  and 
warts. — Langston  Parker. 

9* 


102  CUTANEOUS    FIl  ARMAOOP(£IA. 

8.  Carbolic  acid,  1  part ;  alcohol,  1 — 4  parts. 
Used  iii  lupus,  syphililic  ulcers. 

9.  Nitrate  of  zinc,  1  part ;  bread  mass,  2  or  3 
parts.     Used  in  lupus,  spread  thinly  on  the  part. 

ASTRINGENTS. 

Alum  and  Zinc. 

10.  Alum,  gr.  xx;  sulphate  of  zinc,  gr.  x; 
glycerine,  5j  ;  rose  water,  %\\.  Used  in  erythema, 
intertrigo,  eczema. 

Tannic  Acid. 

11.  Tannic  acid,  gr.  xl ;  French  vinegar,  ^ss  ; 
distilled  water,  ^viiss.  Used  in  seborrhoea — 
Neligan. 

Myrrh  and  Zinc. 

1 2.  Tincture  of  myrrh,  gtt.  xxx ;  zinc  oxide,  gr. 
XX ;  cold  cream,  5j.  Used  in  prurigo,  erythema, 
lichen. — Neligan. 

Bismuth  and  Vaseline. 

13.  Trisnitrate  of  bismuth,  9ij  ;  lead  solution, 
30  drops  ;  vaseline,  ^j.     For  intertrigo,  eczema,  etc. 

Zinc  and  Glycerine. 

1 4.  Zinc  oxide,  5ij  ;  gh'cerine,  5ij ;  lead  water, 
Siss ;  lime  water,  svj  to  oviij.  Used  in  the  secre- 
tor}'  stage  of  eczema,  in  acne,  lichen,  foul  ulcers, 
impetigo,  herpes. 


SEDATIVES.  103 

Borax  and  Glycerine. 
15.  Borax,  9j  or  5j ;  glycerine,  5'j  5  ^'ose  water, 
,^viij.     Used  in  squamous  diseases. 

Acid  and  Lead. 
IG.  Dilute  hydrochloric  or  nitric  acid,  3ss ;  lead 
acetate,  gr.  v  to  x;    glycerine,  5iss ;    water,  5vj. 
Used  in  eczema  and  lichen. 

Alum. 
11.  Alum,  5ij ;   infusion  of  roses,  .5xx.      Used 
in   acne,  pityriasis^  and   eczema   (sine  crustis). — 
Cazenave. 

SEDATIVES. 

Soda. 

18.  Carbonate  of  soda,  5ss  ;  conium  juice,  ^ j  • 
elderflower  water,  ^vj.  Used  in  eczema,  lichen, 
ui^ticaria,  to  allay  itching. 

19.  Bicarbonate  of  soda,  5 J  >  glycerine,  5iss; 
elderflower  water,  ^viss.  Used  as  above  and  in 
acne  punctata. 

20.  Borax,  5y  5  cherry  laurel  water,  ^j  ;  elder- 
flower water,  ovij.     Used  in  lichen. 

Morphia. 

21.  Borax,  ^ss;  sulphate  of  morphia,  gr.  vj  ;  rose 
water,  5viij.     Used  in  prurittis  vulvae. — Meigs. 

22.  Solution  of  hydrochlorate  of  morphia,  Jiss  ; 


104  CUTANEOUS    PH  A  RM  ACOPO:  I  A. 

solution  of  potash,  5u  ;  glyceriue,  sj  ;  cherry  laurel 
water,  ^j  ;  eklcrflower  water,  to  ^xij.  Used  in 
pruriginous  eriqilwis. 

Hydrocyanic  Acid. 

23.  Perchloride  of  mercury,  gr.  j  ;  dilute  hydro- 
cj'anic  acid,  3j ;  emulsion  of  almonds,  .^vj.  Used 
in  itching,  lichen,  and  jjrurigo. 

24.  Dilute  hydroc3anic  acid,  5j  *»  solution  of  ace- 
tate of  ammonia,  oij  ;  tincture  of  digitalis,  5iij  > 
rose  water,  5  v.  Used  in  j^rurit us,  prurigo,  lichen, 
urticaria. — Thomson. 

25.  Dilute  hydrocyanic  acid,  S'j  ;  borax,  5j  ;  rose 
water,  sviij.  Used  in  pruritus  of  old  people — 
Neligan. 

Cyanide  of  Potassium. 

26.  Cyanide  of  potassium,  gr.  vj  ;  cochineal,  gr.  j  ; 
cold  cream,  5j.  Used  in  pruritis,  urticaria. — 
Anderson. 

27.  Cyanide  of  potassium,  gr.  xv;  water,  ^viij. 
Used  in  pudendal  irritation,  lichen,  and  prurigo. — 
Hardy.     (N. B.)  Keep  it  in  a  dark  place. 

Chloroform. 

28.  Carbonate  of  lead,  5ss;  chloroform,  n^^iv; 
cold  cream,  |j.     Used  in  pruritus. 

29.  Cyanide  of  potassium,  gr.  iv;  chloroform 
ni^viij  ;  glycerine,  5j  ;  white  wax  ointment,  ^\j. 
Used  in  pruritus. — Neligan. 


SEDATIVES.  105 

30.  Chloroform,  .Sj  ;  gl^x'crine,  5iv. — Diipnrc. 

31.  Bichloride  of  mercury,  gr.  iss ;  chloroform, 
nixx  ;  glycerine,  5ij  ;  rose  water,  .?vj.  Used  in 
itching,  papular,  and  vesicular  diseases,  and  urti- 
caria.— Burgess. 

Belladonna. 

32.  Extract  of  belladonna,  ,?ss ;  dilute  hydro- 
cyanic acid,  5SS  ;  glycerine,  |j  ;  water,  §xiv.  Used 
in  papular  and  phlegmonous  affections. — Startin. 

Benzoic  Acid. 

33.  Benzoic  acid,  40  to  60  grains  to  ^vj  of  watei*. 
Used  in  urticaria  to  allay  itching. — Ringer. 

Digitalis. 

34.  Tincture  of  digitalis,  5'j  to  J^iv;  glycerine, 
Iss;  rose  water,  |vj.  Used  in  pri^nVus  of  a  purely 
neurotic  character. 

Lead. 

35.  Carbonate  of  lead,  gr.  iv;  glycerine,  5j  ;  sim- 
ple cerate,  5j.  Used  in  erythema. 

36.  Glycerine,  subacetate  of  lead,  and  vaseline. 
Made  by  Squire,  217  Oxford  Street.  In  intertrigo, 
eczema. 

Acetate  of  Ammonia. 
3T.  Solution  of  acetate  of  ammonia,  gij  ;  alcohol, 
oSs;  rose  water,  ^iv.     Used  in  lichen. — Burgess. 


106  CUTANEOUS     PII  ARM  ACOPCEI  A. 

Carbolic  Acid. 

38.  Liquid  carbolic  acid,  ^ss  ;  water  to  Oj.  Used 
to  allay  itching  in  chronic  eczema  or  psoriasis. 

Zinc. 

39.  Oxide  of  zinc,  5'j  ;  solution  of  lead,  5j ;  wine 
of  opium,  5j ;  poppy  decoction,  ^iv.  Used  in 
eczema^  herpes^  etc. 

40.  Oxide  of  zinc,  5j  5  carbonate  of  lead,  5j  ; 
spermaceti,  5j  ;  olive  oil,  q.  s.  To  make  a  soft 
ointment.  Used  in  seborrhoea,  where  the  skin  is 
inflamed — Neumann. 

Camphor. 

41.  Camphor,  58s;  alcohol,  q.  s. ;  oxide  of  zinc, 
starch,  aa  Jj.  Used  as  a  powder  to  allay  burning 
heat  of  eczema. — Anderson. 

42.  Camphor,  gr.  viij  ;  tincture  of  conium,  5'j  ; 
simple  cerate,  |j Neligan. 

43.  Camphor,  5ss  or  5j;  alcohol,  5j;  borax,  3ij  ; 
rose  water,  5 viij.  Used  in  j^^^^^^^s,  eczema^  and 
the  erylhemata. 

44.  Sulphate  of  atropine,  gr.  j ;  borax,  5ij  5  gly- 
cerine, 5iij  ;  distilled  water  to  sxij.  Used  to  allay 
pruritus  in  various  diseases  where  skin  is  not 
abraded. 

Borax. 

45.  Borax,  9ij ;  carbonate  of  soda,  5j  >  gb'- 
cerine,  Siss ;  dilute  hydrocyanic  acid,  it^^xxx ;  dis- 


STIMULANTS    AND    ABSORBENTS.        lOT 

tilled  water,  3vj.     Usetl  in  vesicular  and  sebaceous 
diseases. 

46.  Borax,  9ij ;  oxide  of  zinc,  5j  ;  solution  of 
subacetato  of  lead,  5ij  5  Vmie  water,  svj  to  5viij. 
Used  in  eczema  and  herpes. 

47.  Borax,  5j  to  3ij  ;  glycerine,  5j  ;  lard,  ^j. 
Used  in  parasitic  diseases,  eczema,  erythema,  inter- 
trigo, lichen. 

ABSORBENT  POWDERS. 

48  (a).  Powdered  maize,  oiv;  oxide  of  zinc,  .^j  ; 
calamine,  5ss.     Used  to  excoriated  surfaces. 

48  {h).  Powdered  maize,  ^iv;  oxide  of  zinc,  gj  ; 
iris  powder,  sss;  oil  of  almonds,  gtts.  x. 

49.  The  white  Fuller's  earth,  or  Cimolite,  pre- 
pared by  Taylor,  Baker  Street. 

STIMULANTS  AND   ABSORBENTS. 

50.  Alcohol,  oil-cade,  soft  soap,  aa  5j  ;  oil  of 
lavender,  51ss.  Used  in  eczema  and  2^^oriasis. — 
Anderson. 

51.  Soft  soap,  3ij ;  spirits  of  wine,  5j  ;  dissolve, 
filter,  and  add  spirits  of  lavender,  5ij-  Used  in 
seborrhoea. — Kalicreme  of  Hebra. 

Iodide  of  Starch  Paste.    (Univ.  Coll.  Pharm.) 

52.  Powdered  starch,  1  part ;  glycerine,  2  parts  ; 
water,  6  parts  :  boil  together,  and  when  nearly  cold 
add  solution  of  iodine,  1  part.  Useful  to  cleanse  and 
heal  foul  sores,  especially'  such  as  are  syphilitic. 


108  CUTANEOUS    PHARMA0OP(£I  A. 

53.  Lead  plaster,  58s ;  almond  oil,  3S8 ;  bcnzoated 
oxide  of  zinc  ointment,  5ij.  .  To  be  used  in  eczema 
as  an  astringent  dressing. 

54.  Iodoform,  gr.  xxx-lx;  lard,  3j.  Used  to 
dress  painful  burns,  ulcers,  chancres,  and  boils. 

Mercurial. 

55.  Calomel,  5j  I  lard,  5j.  Used  in  herpes, 
psoriasis,  pruritus  vulvae. 

56.  The  oleates  of  mercury,  5  and  10  per  cent. 
Useful  in  ringworm,  syphilis,  sycosis,  etc. 

57.  Green  iodide  of  mercur}-,  gr.  ij  to  gr.  xv ; 
lard,  ^j.     Used  in  acne. — Hardy. 

58.  Calomel,  5j  5  camphor,  5ss ;  spirits  of  wine, 
q.  s. ;  lard,  ^j.  Used  in  pruritus  of  the  anal  region, 
and  in  syphilitic  ulceration. 

59.  Bicyanide  of  mercury,  gr.  v  to  gr.  x ;  lard, 
5j.     Used  for  syphilitic  tubercles. 

60.  Red  oxide  of  mercur}-,  finelj-  powdered,  and 
ammoniated  mercury,  aa  gr.  vj ;  lard,  |j.  The 
"  Unguentum  mercuriale  co."  Used  in  sebaceous, 
squamous,  ulcerous,  tubercular,  and  papular  erup- 
tions.— Startin. 

61.  Iodine,  ^ss  ;  glycerine,  .^ij  ;  olive  oil,  Siijss; 
strong  mercurial  ointment,  5ij.  The  Linimentum 
hydrarg.  et  iodini  of  Startin.  Used  in  tubercular 
and  cachectic  affections. 

62.  Ammoniated  mercury,  gr.  xx  ;  nitrate  of 
mercury  ointment,  gr.  xx ;  acetate  of  lead,  gr.  x ; 
oxide  of  zinc,  gr.  xx;  purified  palm  oil,  5ss;  fresh 


STIMULANTS  AND  ABSORBENTS.   lO'J 

lard,  Jss.     Used  in  eczema  of  the  head,  in  children 
especially, 

63.  Nitrate  of  mercury  ointment,  5j  ;  solution  of 
lead,  5iss ;  oxide  of  zinc,  5j  ;  carbolic  acid,  gr.  v ; 
fresli  lard,  5j.  Used  in  inflamed  or  irritable 
psoriasis. 

Sulphur. 

64.  Iodide  of  sulphur,  gr.x  to  5j ;  lard,  5j'  Used 
in  acne. 

65.  Milk  of  sulphur,  5ij  ;  ether,  |ss;  spirits  of 
wine,  5iij ;  glycerine,  5iij ;  I'ose  water,  svj.  To  be 
dabbed  on  to  indolent  acne,  indiirata,  or  rosacea, 
allowed  to  remain  a  moment  or  two,  and  then  dried 
off  with  linen. 

66.  Hypochloride  of  sulphur,  5ij  ;  carbonate  of 
potash,  gr.  x  ;  lard,  gj  ;  oil  of  bitter  almonds,  gtt.  x. 
Used  in  acne — Wilson. 

67.  Sulphur,  glycerine,  rectified  spirits  of  wine, 
carbonate  of  potash,  sulphuric  ether,  equal  parts. 
To  be  rubbed  on  to  tlie  part  affected  with  comedo 
with  friction. 

Tar. 

68.  Tar,  alcohol,  aa  Sj.     Used  in  psoriasis  chiefly. 

69.  Pyroligneous  oil  of  juniper,  5j  to  ^j  ;  mutton 
suet,  sss ;  -lard,  5j.  Used  in  eczema  and  psoriasis 
palmaris,  etc. 

70.  Tar,  5j ;  camphor,  gr.  x;  lard,  5x.  Used  in 
pruritus,  and  in  vesicular  and  j9ap«/ar  diseases, — 
Baum4 

10 


1  1  0  CUTANEOUS     I'  II  A  B  M  A  C  O  r  CE  I  A  . 

71.  Detergent  solution  of  tar,  5'j  to  .^j ;  gl^'ce- 
line,  5ij '»  rose  water  to  oviij.  Used  in  cluonic 
scal^',  itchy  conditions  (dilute  hydroc3'anic  acid  may 
be  added,  ii\,xxx). 

Silver . 

72.  Silver  nitrate,  gr.  ij  to  gr.  x ;  water,  5j. 
Used  in  eczema  and  erythemala. 

Bismuth. 

73.  Bismutli  nitrate,  5'j  ;  mercurj'  pcrcbloride, 
gr.  X  ;  spirits  of  camphor,  5ss ;  water,  q.  s.  ad  5xvj. 
Lotio  bismuthi  nitratis.  Used  in  scbacco'.is^piislu- 
/a7',  and  vehicular  diseases,  and  in  pilyriasis.  Use 
diluted  with  1  to  3  parts  water. — Startin. 

Zinc. 

74.  Oxide  of  zinc,  5'j  j  calamine  powder,  Jss  ; 
glycerine,  5ij  ;  rose  water,  5vj.  Used  in  eczema^ 
especially  where  the  surface  is  red  and  tender.  A 
grain  of  the  perchloride  of  mercury  may  be  added. 

75.  Sulphate  of  zinc,  5ss  ;  oxide  of  zinc,  5j; 
alum,  5j ;  glycerine,  5'j ;  '"ose  water  to  5vj  or 
more.  Used  in  scal}"^  stages  of  eczema^  indolent  in- 
tertrigo^ etc. 

Hebra's  Ung.  Diachyli. 
7G.  This  is  made  by  boiling  together  olive  oil, 
.'xv,  and  litharge,  ^iij  et  5vj,  to  a  good  consistence, 
and  adding  oil  of  lavender,  5'j.     Used  in  eczema, 
applied  twice  a  day  on  linen. 


MIXTURES.  Ill 

17.  Snbcarbonate  of  soda,  5ij ;  extract  of  opium, 
gr.  x;  slaked  lime,  5j  '■>  lead,  ^ij.  Used  for  severe 
itching  in  prurigo. — Biett. 

T8.  Nitrate  of  mercury  ointment,  5ij ;  campho- 
rated oil,  glj'cerine,  aa  ^ss.     Used  in  psoriasis. 

PLASTERS. 

79.  Camphor,  5ss ;  black  pitch,  S^'j  ;  yellow 
wax,  5ix  ;  red  oxide  of  lead,  .^ij ;  olive  oil,  .^i v.  To 
be  melted  together  till  a  little  burned.  Used  in 
boils.     (Emplastrum  fuscum.) 

80.  Mercury,  "^xw  ;  turpentine,  5ij  I  yellow  wax, 
5iij ;  lead  plaster,  oiss.  Used  in  acne  rosacea — 
Neumann.     [Emplastrum  hydrargyri.) 

81.  Mercurial  plaster,  soap  plaster,  iiii  oj-  Used 
for  syphililic  papules^  tubercles^  and  indurations 
generally. 

82.  Ammoniated  mercury,  3ss;  soap  plaster,  5 ss. 
Used  in  syphilitic  excoriations  and  ulcei-ations. — 
Sigmund. 

83.  Red  oxide  of  mercury,  5ss ;  ammoniated  mer- 
cury, 5ss ;  soap  plaster,  §ij.  Used  in  syphilitic 
cracks  and  fissures  about  the  hands,  indurations^ 
etc. 

MIXTURES. 

84.  Perchloride  of  mercury,  gr.  ^\  to  ^',  dilute 
hydrochloric  acid,  gtt.  x;  water,  5j.  Take  for  one 
dose. 

85.  Perchloride  of  mercury,  gr.  j ;  iodide  of  po- 


112  CUTANEOUS    PHARM  ACOPCEIA. 

tassium,  ^ij ;  water,  ^iij.     A  dessertspoonful  three 
times  a  day.     Used  in  acne Burgess. 

86.  Perchloride  of  mercury,  gr.  y'^;  iodide  of  po- 
tassium, gr.  v;  compound  tincture  of  iodine,  n\,iij  ; 
water,  ^iss.    Twice  a  day.     Used  in  syphilis. 

87.  Perchloride  of  mercury,  gr.  ^  to  y'g ;  arsenious 
acid,  gr.  5*^  to  ^'^ ;  water,  ^ss.  For  one  dose  in 
ch ro n ic  syphilis. 

88.  Iodide  of  potassium,  5ss — 3"j  >  sal  volatile, 
5iij  ;  syrup  of  orange-peel,  5iv;  water  to  .Iviij.  A 
sixth  part  with  half  a  tumbler  of  water  twice  a  day. 
The  dose  of  iodide  of  potassium  may  l)e  increased 
gradually  up  to  gr.  xxx  if  required..  Used  in  secon- 
dary and  lerliary  syphilis. 

89.  Iodide  of  potassium  5ss  «ind  upwards ;  po- 
tassio-tartrate  of  iron,  5j  ;  syrup,  5ss ;  water,  5vj. 
One-sixth  part  for  a  dose  in  chronic  syphilis  in 
anaemic  subjects. 

90.  Wine  of  ifon,  ^iss ;  simple  syrup,  sss; 
Fowler's  solution,  gtt.  xlviij ;  distilled  water,  to 
S\'j.     Dose:  a  tablespoonful  twice  or  thrice  a  day. 

91.  Fowler's  solution,  n\,lxxx;  iodide  of  potas- 
sium, gr.  xvj  ;  iodine,  gr.  iv ;  orange-flower  water, 
^ij.  Pose:  a  teaspoonful  with  water  three  times  a 
day.     Used  in  eczema. — Neligan. 

92.  Cod-liver  oil,  |ij  ;  yolk  of  egg,  tt\^j  ;  Fowler's 
solution,  n\^lxiv  ;  syrup,  5'j  ;  <listilled  water,  q.s. 
ad  5iv.  Dose:  one  teaspoonful  three  times  a  day. 
— Wilson. 


MIXTURES.  113 

93.  Arseniate  of  sodn,  gr.  i  to  ij  :  distilled  water, 
5viij.     Dose  :  one  tablespoonful  twice  daily. 

94.  Hydrochloric  solution  of  arsenic,  5ss  ;  dilute 
hydrochloric  acid,  5j  ;  tincture  of  the  perchloride 
of  iron,  5iss  to  Jiij ;  water,  .sviij.  Dose:  a  sixth 
part  three  times  a  day.  In  psoriasis  and  eczema 
in  anaemic  subjects. 

95.  Sulphate  of  magnesia,  5iij  ;  sulphate  of  iron, 
gr.  xij  ;  dilute  sulphuric  acid,  5ss;  infusion  of  quas- 
sia, q.  s.  ad  ^viij.  Dose :  one-sixth  part  twice  daily. 
Used  in  acne,  eczema,  impetigo,  and  ulcerous  affec- 
tions.    Quinine  may  be  added  if  desirable. 

96.  Sulphate  of  magnesia,  5iv;  carbonate  of 
magnesia,  5j  ;  tincture  of  colchicum,  n\^xxxvj  ;  oil 
of  peppermint,  ni,ij  ;  water,  oviij.  Dose:  a  sixth 
part.  Used  in  erythemata,  pajjular,  and  acute 
forms  of  disease  in  loaded  habits. 

97.  Bicarbonate  of  soda,  5iij;  tincture  of  calumba, 
5iij ;  sal  volatile,  5iij ;  dilute  hydrocyanic  acid, 
Tii^viij;  syrup  of  ginger,  5iij  ;  water,  gvj.  Dose: 
a  sixth  part  an  hour  before  two  principal  meals. 
Used  in  dyspepsia. 

98.  Acetate  of  potnsh,  5j ;  acetic  acid,  5ss ; 
spirits  of  nitrous  ether,  .^iss ;  fluid  extract  of 
taraxacum,  §ij.  Dose:  a  teaspoonful  with  water 
before  meals.     Used  in  acne  indurata Bulkley. 

99.  Iodide  of  sodium,  gr.lx;  compound  decoction 
of  sarsapariila,  oviij.  Dose:  a  sixth  part  three 
times  a  day  in  obstinate  syphilitic  eruptions,  where 
iodide  of  potassium  disagrees  or  fails. 

10* 


114  CUTANEOUS    rn  ARM  ACOPCEI  A. 

100.  Turpentine  rectified,  5s8  to  5is8;  creasote, 
n\,iij;  spirits  of  rosemary,  n\,xl;  water,  q.  s.  ad 
5iv.  Dose:  two  teaspoonfuls  every  three  Lours. 
Used  in  purpura. — Budd. 

101.  Acid  tartrate  of  potash,  5iij  ;  decoction  of 
broom,  5vj.  Dose  :  two  tablespooululs  three  times 
a  day.  Used  as  a  diuretic  and  aperient  in  eczema 
of  the  legs  with  oedema. 

102.  Acetate  of  potash,  5i'j ;  vinegar  of  squill, 
5iij ;  sweet  spirits  of  nitre,  n^^xx ;  compound 
decoction  of  broom,  5viij.  Dose:  a  sixth  part 
thrice  a  da3\  Used  as  a  diuretic,  where  the  skin  is 
very  hyperaemic  and  the  urine  not  freely  voided. 
Digitalis  may  be  added  if  desired. 

103.  Strychnine,  gr.  ^ — 1 ;  dilute  phosphoric 
acid,  5iij  ;  tincture  of  orange-peel,  5ss  ;  infusion  of 
cloves,  §xj.  Dose:  half  an  ounce  three  times  a 
-day.     Used  in  prurigo  and  lichen. 

PILLS. 

104.  Red  iodide  of  mercury',  gr.  j  to  ij  ;  extract 
of  gentian,  9 ij.  Make  12  pills.  One  pill  twice  a 
day. 

105.  Bicyanide  of  mercur3',  gr.  j  ;  quinine,  gr. 
XX  ;  extract  of  gentian,  gr.  xxx.  To  make  20  pills. 
One  twice  a  day.  Used  in  ordinary  syphilitic 
eruptions. 

106.  Arseniate  of  soda,  gr.  ij  ;  water  suflScient  to 
dissolve ;  guaiacum  powder,  5ss ;  suli)hurated  mer- 
cury, 9j.     Mucilage    sufficient  to  make  2-f  pills. 


REMEDIES     FOR    PHTIIIRIASIS.  115 

One  pill  two  or  three  times  a  day.    Used  in  chr-onic 
skin  diseases. — Wilson. 

lOT.  Levigated  arseuious  acid,  gr.  v ;  powdered 
acacia,  5ss ;  cinnamon  powder,  5iij ;  glycerine, 
enough  to  make  100  pills.  (Pil.  arsenicalis  comp.) 
Dose :  one  or  two  a  day. 

108.  Arsenious  acid,  gr.  j  ;  quinine,  gr.  20-30  ; 
dried  sulphate  of  iron  or  reduced  iron,  gr.  xl-lx ; 
extract  of  hop,  gr.  x  ;  extract  of  gentian,  q.  s.  To 
be  well  mixed  and  divided  into  20  or  16  pills.  One 
twice  a  day  after  a  meal..  Used  in  chronic  skin 
diseases  with  debilit}^ 

109.  Quinine  gr.  1  to  2;  reduced  iron  gr.  ij ;  ex- 
tract of  nux  vomica  gr.  ^ ;  extract  of  chamomile 
gr.  j.     To  be  taken  twice  or  thrice  a  day. 

REMEDIES  FOR  SCABIES  AND 
PHTHIRIASIS. 

110.  Sulphurated  potash,  ^vj  ;  hard  soap,  ftij  ; 
olive  oil,  Oij  ;  oil  of  thyme,  3ij'  Used  in  scabies 
and  prurigo. 

111.  Olive  oil,  ,lij;  sulphate  of  potash,  5^^; 
sulphate  of  soda,  5xv;  precipitated  sulphur,  5x 
Used  in  scabies. — Mollard. 

112.  Sulphur,  tar,  aii  5vj  ;  soft  soap,  lard,  aa 
^xvj  ;  chalk,  §iv.     Used  in  scabies. — Hebra. 

113.  Lard,  ^ij ;  sulphur,  5v;  carbonate  of 
potash,  watei-,  aa  5ij'     Used  in  scabies. — Hardy. 

114.  Sublimed  sulphur,  5ss;  ammoniated  mer- 


IIG  CUTANEOUS     PII  A  RM  ACOP(EI  A. 

ciiry,  gr.  v;  creasote,  gtt.  iv;  olive  oil,  S'j  ;  fresh 
hird,  5j.     Used  iu  scabies. 

115.  Olive  oil,  5SS  ;  lard,  58S  ;  powdered  staves- 
acre,  5ij'  Soak  tlie  stavesacie  in  iiot  oil  and  mix. 
Used  in  phthiriasis. 

116.  Quicklime,  Ibj  ;  flowers  of  sulphur,  Ibij  ; 
water,  ibxx.  Boil  until  12tb  remain,  and  then 
filter.     Used  in  scabies Vlemingk's  Solution. 

117.  Iodide  of  potassium  ointment  is  very 
eflQcaeious  in  scabies. 

118.  Sulphur  ointment,  3ij  ;  oil  of  chamomile, 
gtt.  XX.     Used  in  scabies. 

119.  For  phthiriasis  the  ordinary  white  precipi- 
tate ointment  of  the  Pharmacopo9ia  is  as  good  a 
remedy  as  any,  diluted  from  5  to  10  times. 

120.  Liquid  storax,  3j  >  lard,  Jij.  Melt  and 
strain.  Used  in  scabies. — Anderson.  A  little  sul- 
phur may  be  added  if  thought  desirable. 

REMEDIES  FOR  VEGETABLE  PARASITIC 
DISEASES. 

121.  Perchloride  of  mercury,  gr.  x  to  xx;  elder- 
flower  ointment,  oj-  L^sed  in  the  early  stages  of 
fovus  and  ti7}ea  tonsic7-ans. 

122.  Carbolic  acid,  5j  ">  glycerine,  ^ss  to  3j. 
Used  in  tinea  tonsurans.  Or  the  same  with  rose 
water,  siv,  in  tinea  circinata. 

123.  Hyposulphite  of  soda,  |iij  ;  dilute  sulphurous 
acid,  |ss ;  water,  q.  s.  ad  5xvj.  Used  in  all  forms 
of  parasitic  disease. —  Startin. 


REMEDIES    FOR    PARASITIC    DISEASES.       Ill 

124.  Perch loride  of  mercury,  gr.  ij  toiv;  alcohol, 
5iv  ;  chloride  of  ammonium,  5ss  ;  rose  water,  q.  s. 
ad  Jvj.  Used  in  scabies,  lihthiriasis,  and  tinea 
versicolor. 

125.  Saturated  solution  of  sulphurous  acid,  1 
part ;  water,  2-4  parts.     Used  in  all  the  linese. 

126.  Pyroligneous  oil  of  juniper,  5ij  to  5iv  ;  lard, 
^iiss.     Used  in  tinea. 

127.  Hyposulphite  of  soda,  5iv;  glycerine,  ^j  ; 
distilled  water,  |vj.  Used  in  pruritus  vulvae  and 
tinea  versicolor. 

128.  Ammoniated  mercury,  gr.  yj-xxx  ;  red  oxide 
of  mercury,  powdered,  gr.  vj — xxx  ;  lard,  sj.  Used 
in  all  forms  of  ringworm. — Startin. 

129.  Strong  ammonia  liniment,  ^ss;  castor  oil, 
§ss;  spirits  of  turpentine,  purified,  |ss;  ammoniated 
mercury,  gr.  xv.  Brush  into  the  scalp  with  a  hard 
brush  until  irritation  is  set  up.     For  Baldness. 

130.  Tincture  of  cantharideSjfj;  distilled  vinegar, 
^iss  ;  glycerine,  5iss ;  spirits  of  rosemary,  3iss ; 
rose  water,  5viij.  To  be  well  sponged  into  the 
scalp  night  and  morning. 

131.  Blistering  fluid,  5j  ;  sulphate  of  zinc,  gr.  xx ; 
balsam  of  Peru,  5iss ;  powdered  galls,  5ij ;  lard,  §j. 
For  tinea  tonsurans. 

132.  Subacetate  of  copper,  gr.  xxx;  birch  oil, 
5iij  ;  lard,  |j.     Same; 

133.  Sulphur,  tar,  tincture  of  iodine,  aa  ^j ;  lard, 
SJ.     Same. 

134.  Carbolic  acid,  3J  ;   sublimed  sulphur,  5i'j  ; 


118  0UTANK0U8    P  11  A  R  M  AGO  P(E  I  A. 

tincture  of  iodine,  5iij  ;  vaseline  (gelatura  petiolei) 
or  lard,  5j'     In  tinea  tonsurans. 

135.  Blistering  fluid,  3j  ;  sulphate  of  copper,  9ij ; 
powdered  galls,  .^j  ;  vaseline,  ,^j.     For  ringworm. 

136.  Iodine,  5j — ij  ;  colorless  oil  of  wood  tar, 
oj.     This  preparation  is  known  as  "  Coster's  paste." 

DIET  IN  SKIN  DISEASES. 

There  are  one  or  two  observations  to  be  made  on 
this  subject  that  may  Jje  of  use  in  the  management 
of  these  diseases. 

Firstly. — A  distinction  must  be  made  between 
the  diet  of  the  private  and  hospital  patient.  The 
latter  often  only  requires  to  be  well  fed  up,  and  his 
disease  then  speedily  goes  ;  the  former,  on  the  other 
hand,  often  needs  to  have  a  check  put  on  the  quan- 
tity and  quality  of  his  food. 

Secondly. — In  ciiildren  skin  diseases  may  arise 
directly  from  defective  alimentation,  as  in  the  case 
of  eczema;  and  it  is  frequently  the  case  that  the 
child,  the  subject  of  eczema,  intertrigo,  or  psoriasis, 
has  not  a  sufl^cient  supply  of  milk,  either  from 
excessive  dilution  or  otherwise. 

Thirdly. — The  regulation  of  the  diet,  setting 
aside  the  question  of  quantity  or  quality,  is  as  a 
rule  needed  not  so  much  to  directly  influence  the 
skin  disease  as  certain  states  of  the  general  health ; 
which  modif}-^  the  particular  disease  present ;  for 
instance  to  meet  especially  dyspeptic,  gouty,  and 
rheumatic  conditions,  but  particularly  the  former. 


DIET    IN    SKIN     DISEASES.  119 

In  (l^^spepsia  in  connection  with  eczema,  acne, 
psoriasis,  or  congestion  of  tlie  face,  it  is  advisable, 
especially  if  the  urine  l)e  very  acid,  to  avoid  sugar, 
tea,  coffee,  alcoholics,  beer,  raw  vegetable  matter, 
with  unripe  or  uncooked  fruit,  veal,  pork,  seasoned 
dishes,  pastry,  and  the  coarser  kinds  of  vegetables, 
but  especially  all  articles  whose  use  is  followed  by 
heat  or  flushing  of  the  face  and  by  flatulence  and  the 
like.  Milk,  the  common  meats,  a  light  kind  of 
bread,  and  some  very  light  wine  should  be  the  diet 
of  dyspeptic  patients,  whose  skins  are  at  all  in  a 
state  of  irritation.  In  ver}'  many  cases  the  stomach 
is  at  fault  at  the  outset,  and  a  careful  regulation  of 
the  diet  is  of  the  utmost  importance  as  an  aid  to 
the  other  means  adopted  to  correct  faults  in  other 
parts  of  the  S3stem. 

In  gouty  subjects  much  the  same  line  is  to  be 
pursued.  As  regards  stimulants,  hock,  a  good 
light  claret,  Moselle  even,  but  not  the  sparkling, 
or  whisky  in  Vals  water,  are  the  best  beverages. 

In  strumous  subjects,  the  diet  should  consist  of 
as  much  fatty  matter  as  possible. 

Fourthly. — In  children  who  suffer  from  ringworm, 
it  is  desirable  to  give  as  much  fatty  matter  as  possi- 
ble, by  means  of  milk,  cream,  eggs,  and  fat  meat  if 
the}-  be  got  to  eat  it. 

Fifthly. — In  syphilis,  the  greatest  care  should  be 
taken  to  avoid  anything  beyond  the  most  moderate 
use  of  stimulants:  their  abuse  in  this  disease  is  a 
source  of  the  greatest  aggravation. 


120  CUTANEOUS    PIIARMACOPCEIA. 

Sixthly. — In  all  cases  in  wliich  the  onset  or  early 
stage  of  a  skin  disease  is  accompanied  b}'  febrile 
disturbance,  however  slight,  or  in  which  the  disease 
is  very  hypera.Mnic,  stimulants  should  be  avoided, 
and  the  plainest  and  simplest  diet  ordered.  In 
marked  cases  of  this  kind,  a  milk  diet  for  a  while  is 
often  found  to  be  very  beneficial. 

Seventhly. — In  some  eases  in  which  the  skin  is 
hyperremic,  this  condition  is  much  increased  by  the 
ingestion  of  food,  esi)ecially  if  dyspepsia  exists,  in 
consequence  of  the  sympathy  existing  between  the 
stomach  and  the  skin  of  the  part  affected.  This 
state  of  things  is  especiull}- marked  in  such  diseases 
as  acne,  congestion  of  the  face,  and  non-parasitic 
sycosis.  Stimulants  must  be  avoided,  except  thej' 
be  diluted  with  some  alkaline  water:  the  use  of  a 
diet  appropriate  to  the  dyspepsia  must  be  rigorously 
enforced. 

Eighthly. — It  is  said  that  psoriasis  requires  an 
ample  meat  diet.;  but  the  patient  must  be  dieted, 
and  not  his  disease — i.  e.,  the  diet  should  be  plain 
and  nutritious,  and  adapted  to  the  constitutional 
peculiarities  of  the  individual  according  to  circum- 
stances. 

Ninthly. — In  all  cases  where  a  skin  disease  has 
become  chronic,  and  where  there  is  debility,  the 
patient  should  be  allowed  a  fall,  unstimulating 
diet. 

THE  END. 


University  of  California 

SOUTHERN  REGIONAL  LIBRARY  FACILITY 

405  Hilgard  Avenue,  Los  Angeles,  CA  90024-1388 

Return  this  material  to  the  lit>rary 

from  which  It  was  bofrowed. 


^i^jcyi^^t^  .  ^",^^=7^ 


UC  S0UTHER«J  RC 


ii-n 


A  000  431  495  1 


WRlUO 
F79^e 
1876 
Fox,  Tilbury* 

Epitoire  of  skin  diseases . . . 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE,  CALIFORNIA  92664 


